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/Medical  Diagnosis 


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MANUAL 


OF 


Differential   Medical  Diagnosis 


BY 


CONDICT  W.  CUTLER,  M.S.,  M.D. 

PHYSICIAN   TO   THE   NEW    YORK   DISPENSARY,  ASSISTANT    SURGEON    NEW    YORK 

HOSPITAL,  OUT-DOOR  DEPARTMENT  ;    LATE  HOUSE  PHYSICIAN 

BELLEVUE  HOSPITAL,  ETC.,  ETC. 


SECOND  EDITION,  REVISED 


NEW  YORK  •&  LONDON 

G.    P.    PUTNAM'S    SONS 

Wai  ^ttick£rbotk£i:  ^wss 

1887 


COPYRIGHT   BY 

CONDICT  W.  CUTLER 
1886 


ISBl 


Press  of 

G.  P.  Putnam's  Sons 

New  York 


TO 

CHARLES  H.  WILKIN,  M.D. 

THIS    SMALL   VOLUME 

IS   DEDICATED 

AS   A   TOKEN   OF   RESPECT    AND    FRIENDSHIP 

BY  THE 

AUTHOR 


PREFACE  TO  THE  SECOND  EDITION. 


This  little  work  has  rapidly  run  through  its  first  edition,  and  has  been  favor- 
ably received  by  the  profession  and  students  in  medicine. 

In  the  preface  of  the  first  edition,  published  less  than  a  year  ago,  I  then 
wrote  : 

"In  compiling  this  Manual  of  Medical  Diagnosis  I  am  fully  aware  of  the 
uncertainty  of  the  so-called  characteristic  symptoms  of  a  disease. 

"  I  have  therefore  endeavored  in  the  following  pages  to  contrast  the  symp- 
toms of  the  diseases  that  are  most  liable  to  be  confounded  one  with  another, 
and  have  chosen  for  such  symptoms  those  that  will  most  readily  call  forth  a 
differential  diagnosis. 

"  Although  not  relying  upon  any  one  symptom  as  diagnostic,  I  have  limited 
myself  to  those  that  afford  the  most  striking  contrast,  and  thus  have  avoided 
any  unnecessary  multiplication  of  the  pages  that  are  intended  only  to  serve  as 
a  text-book. " 

In  this  new  edition  some  few  corrections  are  made,  and  a  chapter  on  the 
differential  diagnosis  of  coma  added,  which  will,  I  trust,  further  increase  the 
merits  of  the  book  and  make  it  still  more  worthy  of  the  approval  of  the  pro- 
fession. 


150  West  530  St.,  New  York,  May,  1887. 


CONTENTS. 


Introduction  .... 

Diseases  of  the  mouth  and  throat 

Diseases  of  the  lungs  and  pleura 

Diseases  of  the  heart  and  blood-vessels     . 

Diseases  of  the  digestive  tract  and  peritoneum 

Diseases  of  the  liver 

Diseases  of  the  kidneys  and  bladder 

Acute  general  diseases — fevers,  etc. 

Chronic  general  diseases — blood  diseases,  etc. 

Diseases  of  the  nervous  system 

Coma  ..... 

Index         ..... 


PAGE 
I 

13 

21 

37 

51 

75 

89 

107 

127 

137 

159 

167 


INTRODUCTION. 


A  CAREFUL  examination  of  a  patient  is  the  first  requisite  tow- 
ard establishing  a  diagnosis.  To  conduct  this  properly  and  to 
the  best  advantage  a  systematic  examination  of  the  patient  will 
lead  to  the  quickest  and  surest  results. 

First  locate  the  disease,  and  then  balance  the  symptoms  struck, 
and  the  diagnosis  is  recast. 

The  following  schedule  will  serve  as  a  guide  toward  the  proper 
examination  of  the  patient,  and  lead  the  observer  quickly  and  in 
.the  right  channel  to  the  seat  of  the  disease,  and  then  to  the  estab- 
lishment of  a  correct  diagnosis  of  his  case. 

I. — History  of  the  Patient. 

a.  Hereditary  predisposition. 

b.  Previous  general  health. 

c.  Previous  diseases  or  injuries. 

d.  Habits  of  life. 

e.  Cause  of  the  present  sickness, 
/.  Date  of  the  present  attack. 

g.  Mode  of  invasion. 

h.  Subsequent  symptoms  in  order. 


2  INTRODUCTION. 

II. — Condition  of  the  Patient. 

a.  Position. 

b.  Aspect. 

c.  Skin. 

d.  Pulse. 

e.  Respiration. 
/.  Temperature. 
g.  Tongue. 

h.  Digestion. 

/.  Urinary  secretion. 

j.  Sensations. 

k.  Intellection. 

/.  Examination  of  special  organs. 

Hereditary  Predisposition. 

Many  diseases,  among  the  most  important  of  which  are  syphi- 
lis, cancer,  tuberculosis,  scrofula,  etc.,  are  hereditary.  The  ob- 
server, by  establishing  a  family  history  of  hereditary  disease,  is 
often  aided  materially  in  coming  to  a  correct  diagnosis  of  the 
case. 

Previous  General  Health. 

The  usual  general  health  of  the  patient  is  often  of  great  im- 
portance for  the  diagnostician  to  know. 

If  the  patient's  health  has  always  been  good  up  to  the  present 
attack  he  is  able  at  once  to  exclude  certain  wasting  and  debili- 
tating diseases. 

While,  on  the  other  hand,  if  the  patient's  previous  condition  has 
been  a  poor  one,  we  at  once  look  for  a  chronic  ailment  as  being 
in  some  way  connected  with  the  present  sickness. 


INTRODUCTION.  3 

Previous  Diseases  or  Injuries. 

The  thorough  knowledge  of  this  important  history  will  fre- 
quently lead  to  a  correct  diagnosis,  for  injury  of  an  organ  often 
results  in  its  disease,  while  previous  disease  makes  the  patient 
either  more  or  less  susceptible  to  a  similar  attack.  Thus  if  the 
patient  gives  a  history  of  having  had  an  eruptive  fever,  as  small-pox, 
we  would  naturally  at  once  exclude  small-pox  from  our  list  of  pos- 
sible diseases  which  might  be  the  cause  of  his  present  symptoms. 

If,  however,  the  patient  had  once  suffered  from  Bright's  disease 
of  the  kidneys,  we  would  immediately  inquire  further  into  the 
condition  of  the  urinary  organs. 

How  simple  many  diagnoses  would  appear  could  we  but  get  a 
syphilitic  history  from  our  patients. 

Habits  of  Life. 

The  habits  of  men  predispose  them  to  certain  diseases,  hence 
the  importance  of  inquiring  into  the  regular  habits  of  our  pa- 
tients. Thus,  for  example,  sedentary  habits  lead  to  gastric,  hepa- 
tic, and  intestinal  disorders  ;  alcoholism,  to  cirrhosis  of  the  liver, 
mental  and  nervous  derangements,  etc. 

The  CAUSE  of  the  present  attack,  its  date,  its  mode  of  inva- 
sion, and  the  subsequent  symptoms  in  the  order  of  their  devel- 
opment are  of  the  utmost  importance,  for  by  obtaining  a  full 
history  of  the  same,  the  physician  is  often  at  once  led  to  an  im- 
mediate and  correct  diagnosis  of  his  case.  » 

Having  thus  obtained  the  previous  history  of  the  patient,  let  us 
now  consider  his  present  condition. 

Position. 

Is  the  patient  in  bed  or  out  of  bed  ?  If  in  bed,  what  is  his  po- 
sition ?     If  feverish  and  in  pain,  he  is  restless  and  tossing  about. 


4  INTRODUCTION, 

If  suffering  from  acute  peritonitis,  there  is  dorsal  decubitus  and 
flexion  of  the  thighs.  If  lying  fixedly  upon  one  side  there  is  a 
probability  that  the  action  of  the  lung  on  this  side  is  impaired. 

If  there  is  orthopno^a  there  is  probably  disease  of  the  heart  or 
respiratory  organs. 

i  If  the  patient  is  out  of  bed,  we  should  notice  his  movements. 
In  nervous  disorders  they  are  uncertain  and  trembling,  and  the 
gait  often  unsteady  and  staggering.  In  rheumatism,  joint-dis- 
ease, etc.,  affecting  the  lower  extremities,  the  patient  limps,  while 
in  many  diseases  of  the  back  there  is  rigidity  of  the  spine  and 
a  bending  forward. 

Aspect. 

By  noting  the  general  aspect  of  the  patient  we  at  once  derive 
knowledge  as  to  the  occurrence  of  oedema,  corpulency,  wasting, 
cyanosis,  etc.  Expressions  of  the  face  denote  pain,  stupor,  apa- 
thy, collapse,  etc.  The  eye  frequently  tells  us  at  once  the  condi- 
tion of  the  patient — whether  delirious,  stupid,  or  approaching 
death.  The  pupils  are  contracted  in  opium-poisoning  (pin  head^ 
and  hemorrhage  into  the  pons  (pin  point)  ;  unequally  dilated  in 
apoplexy  and  compression  of  the  brain,  and  rapidly  dilate  upon 
the  approach  of  death,  etc. 

Skin. 

By  the  state  of  the  skin  we  judge  of  the  activity  of  the  circu- 
lation and  secretions.  Coldness  of  the  surface  indicates  weakness 
of  the  capillary  circulation,  often  due  to  interference  of  nervous 
power  by  some  acute  disease  or  nervous  shock.  A  cold,  clammy 
skin  denotes  diminished  vital  force.  Jaundice  occurs  with 'de- 
rangements of  the  liver  and  blood-diseases.  Eruptions  occur 
with  skin  diseases  and  the  exanthemata. 


INTRODUCTION,  5 

Pulse. 

The  pulse  affords  one  of  the  most  valuable  means  of  informa- 
tion, and  although  it  cannot  be  exclusively  relied  upon  as  a 
means  of  diagnosis  it  comes  greatly  to  our  assistance.  The 
pulse  enlightens  us  as  to  the  action  of  the  heart,  and  the  condi- 
tion of  the  arteries.  The  pulse  differs  in  frequency,  rhythm,  vol- 
ume, and  resistance. 

T\iQ frequency  of  the  pulse  is  usually  greatly  increased  in  all  acute 
affections  and  in  fevers.  In  shock,  in  pressure  on  the  brain,  and  in 
inflammation  of  the  meninges  of  the  brain  a  slow  pulse  is  the  rule. 

The  rhythfu  of  the  pulse  is  often  perverted.  The  irregular 
action  of  the  heart  may  arise  from  digestive  disturbance,  from 
the  excessive  use  of  tobacco  or  stimulants,  from  nervous  exhaus- 
tion, but  most  frequently  in  cerebral  or  cardiac  diseases. 

The  volume  of  the  pulse  often  varies  with  its  strength.  Usually 
a  full  pulse  is  a  strong  pulse,  but  this  is  not  always  the  case.  A 
full,  weak  pulse,  or  "  gaseous  pulse,"  indicates  great  debility  and 
loss  of  tone  in  the  arterial  system.  A  "  gaseous  pulse  "  is  com- 
mon in  yellow  fever  and  ether  narcosis.  On  the  other  hand  a 
small  pulse  is  usually  a  weak  pulse,  but  it  may  be  tense  and  wiry 
as  observed  in  peritoneal  inflammations. 

The  resistance  of  the  pulse  is  perhaps  the  most  important 
guide  as  to  the  real  condition  of  the  patient.  A  hard  pulse  de- 
notes a  forcibly  contracting  heart  and  increased  contractility  of 
the  arteries.  A  hard  pulse  is  also  associated  with  degenerative 
changes  taking  place  in  the  arterial  walls.  A  soft  pulse  is  the 
pulse  of  low  fevers  and  debilitated  conditions. 

By  means  of  the  sphygmographic  tracings,  we  are  afforded  very 
delicate  means  for  obtaining  slight  variations  in  the  pulse,  and 
may  thus  be  assisted  in  diagnosing  valvular  diseases  of  the  heart, 
?.aeurisms,  etc. 


6  INTRPDUCTION. 

Respiration. 

By  noting  the  frequency  and  character  of  the  respiration  we 
can  frequently  make  a  correct  diagnosis  of  thoracic  diseases 
without  further  examination.  If  dyspnoea  is  present,  we  at  once 
suspect  disease  of  the  heart  or  respiratory  apparatus.  If  pleurisy 
is  present,  the  respirations  will  be  hurried,  short,  and  catching 
in  character.  The  breathing  is  "  panting  "  in  pneumonia,  and 
"labored  "  in  capillary  bronchitis. 

The  pulse  and  respiration  should  bear  a  nearly  constant  ratio 
to  each  other  of  about  4  to  i.  If  this  relation  is  increased,  car- 
diac failure  may  be  suspected,  but  if  the  ratio  is  diminished,  and 
the  respirations  are  much  increased  in  frequency,  an  examina- 
tion of  the  respiratory  organs  will  probably  discover  the  cause. 

Opium-poisoning,  compression  of  the  brain,  diseases  of  the 
respiratory  centre,  etc.,  will  reduce  the  frequency  of  the  respira- 
tions. 

Temperature. 

The  temperature  of  the  patient  is  of  the  utmost  importance  in 
making  a  diagnosis.  In  all  acute  cases  the  temperature  is,  as  a 
rule,  elevated. 

Usually  the  pulse  and  temperature  rise  synchronously  ;  that 
is,  for  every  degree  rise  in  temperature,  we  may  expect  an  in- 
crease of  ten  beats  in  the  pulse  rate.  In  some  diseases,  as 
typhoid  fever,  every  'week  presents  characteristic  variations  in 
the  temperature. 

Although  we  are  apt  to  gauge  the  condition  of  our  patient  by 
his  range  of  temperature,  it  must  not  be  forgotten  that  in  condi- 
tions of  prostration,  collapse,  shock,  etc.,  the  temperature  is  often 
normal,  or  even  subnormal.  In  cholera  the  temperature  falls  as 
low  as  94°,  while  in  sunstroke  the  temperature  is  frequently  ob- 


INTRODUCTION.  7 

served  to  be  at  112°.     A  patient  seldom  recovers  if  the  tempera- 
ture remains  for  any  length  of  time  over  108°. 

Tongue. 

The  tongue  not  only  indicates  the  condition  of  the  digestive 
tract,  but  also  gives  us  information  concerning  the  state  of  the 
secretions,  the  blood,  nervous  power,  etc. 

If  the  movements  of  the  tongue  are  tremulous,  one-sided,  or 
crippled,  we  are  dealing  with  a  disease  of  the  nervous  system. 
If  the  tongue  is  dry  and  cracked,  or  covered  with  sordes,  there  is 
good  reason  to  suspect  some  acute  febrile  affection  or  marked 
depression  of  the  vital  forces. 

A  simply  coated  tongue  occurs  frequently  with  some  digestive 
disturbance.  The  C0I07-  of  the  tongue  is  red  in  the  exanthemata, 
especially  scarlet-fever  (strawberry  tongue),  blue  in  asphyxia  and 
obstructed  circulation,  etc. 

Digestion. 

The  state  of  the  digestion  should  always  be  inquired  into. 
Vomiting  occurs  in  many  disorders,  but  frequently  in  diseases  of 
the  stomach  and  brain.  Diarrhoea  denotes  a  disordered  state  of 
the  bowels.  Chronic  constipation  is  frequently  the  result  of  tor- 
pidity of  the  liver.  Foecal  vomiting  and  obstinate  constipation 
result  from  intestinal  obstruction. 

Urinary  Secretion. 

An  examination  of  the  urine  should  never  be  neglected.  The 
kidneys  are  affected  in  so  many  diseases,  that  to  establish  a  diag- 
nosis it  is  often  essential  to  know  the  condition  of  the  urine. 

In  Bright's  disease  the  urine  contains  albumen  and  casts  ;  in 


8  INTRODUCTION. 

cancer  of  the  kidneys,  blood  and  cancer  cells  ;   in  suppurative 

nephritis  and  pyelitis,  a  large  number  of  pus  cells  ;  in  cystitis, 
ropy  mucous,  etc. 

Many  poisons  may  be  detected  in  the  urine.  In  pneumonia 
the  chlorides,  and  in  carbolic-acid  poisoning  the  sulphates  are 
greatly  diminished  in  the  urine. 

Sensation. 

Frequently  the  most-marked  symptom  by  which  we  can  locate 
the  disease  is  the  pain. 

Most  all  affections  are  painful,  and  the  pain  is  usually  referred 
to  the  seat  of  the  disease.  Thus,  diseases  of  the  brain  are  asso- 
ciated with  headache  ;  pleurisy,  with  pain  in  the  side  ;  sciatica, 
with  pain  along  the  course  of  the  sciatic  nerve,  etc. 

Not  only  is  pain  an  important  symptom,  but  disordered  sensa- 
tions, as  numbness,  hypersesthesia,  anaesthesia,  and  subjective  sen- 
sations, lead  us  at  once  to  associate  the  symptoms  with  affections 
of  the  nervous  system. 

Intellection. 

In  affections  of  the  brain  and  in  many  acute  forms  of  disease 
a  deranged  intellect  is  among  the  first  symptoms.  The  de- 
rangement varies  from  a  mere  confusion  of  the  mind  to  its  entire 
perversion  and  prostration.  Acute  diseases  are  associated  with 
stupor,  delirium,  and  coma,  while  in  chronic  affections  loss  of 
judgment,  memory,  etc.,  are  essentially  noticeable. 

Examination  of  Special  Regions  or  Organs. 

Having  thus  obtained  a  general  history  of  the  case,  we  are 
now  prepared  to  examine  some  of  the  special  organs  of  the  body 
for  the  seat  of  the  disease. 


IN  TROD  UC  TION.  9 

If  we  have  reason  to  believe  that  we  are  dealing  with  a  general 
disease,  it  is  more  than  likely  that  some  local  lesion  or  complica- 
tion may  also  exist. 

It  is  therefore  well  to  examine  the  special  organs,  as  the  heart, 
lungs,  etc.,  and  thus  determine  if  some  of  the  symptoms  present 
are  not  due  to,  or  modified  by,  some  complicating  condition. 

Having  thus  determined  the  seat  and  character  of  the  disease, 
let  us  by  a  differentiation  of  the  symptoms  arrive  at  a  correct 
diagnosis. 


DIFFERENTIAL   DIAGNOSIS   OF   THE    DISEASES    OF 
THE    MOUTH   AND    THROAT. 


DIFFERENTIAL   DIAGNOSIS    OF   THE    DISEASES   OF 
THE   MOUTH   AND   THROAT. 


NAME    OF    DISEASE. 

Thrush      .... 
Cancrum  Oris    . 

Cancer  of  Tongue 

Acute  Laryngitis  (croup)    . 

Chronic  Laryngitis    . 
QEdema  Glottidis        ,        • 


Thrush. 

1.  Removal  of  the  white  patch  leaves 

an  ulcer. 

2.  Disease  parasitic  in  nature. 

3.  Redness  around  each  spot. 

4.  Exudation  not  soluble  in  ether. 


DISEASES   TO    BE   DIFFERENTIATED. 

Follicular  stomatitis. 

Malignant  pustule. 
Ulcerative  stomatitis. 

Syphilitic  ulcer  of  tongue. 

False  croup. 

Retro-pharyngeal  abscess. 
CEdema  of  glottis. 
Diphtheria. 

I  Thoracic  aneurism. 

(  Hysterical  change  of  voice. 

Croup. 

Thoracic  aneurism. 
Asthma. 
,  Retro-pharyngeal  abscess. 

Follicular  Stomatitis. 

1.  Removal  of  the  exudation  leaves 

a  red  surface. 

2.  Vesicular  disease. 

3.  No  zone-inflammation  about  exu- 

dation. 

4.  Exudation  soluble  in  ether. 


13 


H 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE. 

Thrush. 

5.  Severe  gastro-intestinal  symptoms. 

6.  Excoriation  about  anus  and  geni- 

tals. 

7.  Acid  diarrhoeal  movements. 

8.  Oidium  Albucans  found  under  the 

microscope. 


Cancrum  Oris. 

Begins  on  the  cheek. 

Some  constitutional  symptoms. 

Rapid  progress  of  the  disease. 
Ulceration  extends  rapidly. 
Discoloration  of  the  cheek. 
Cheek  greatly  swollen. 
7.   Constant  flow  of  bloody  pus  and 
mucus  from  the  mouth. 

Cancrum  Oris. 

1.  Begins  in  the  mucous  membrane. 

2.  No  severe  constitutional  symptoms 

at  first. 
Breath  very  foul. 
Pus    and    blood     flow    from    the 

mouth. 
Some  pain. 
Glands  enlarged. 


Cancer  of  Tongue. 

1.  History  of  hereditary  cancer. 

2.  Appears  on  the  side  of  tongue. 

3.  Usually  single. 

4.  Progress  rapid  and  painful. 


DISEASES  TO  BE  DIFFERENTIATED. 

Follicular  Stomatitis. 

5.  Slight  intestinal  disorder. 

6.  No  redness  about  anus. 

7.  Diarrhoeal  movements  may  be  alka- 

line. 

8.  Oil  globules  under  microscope. 


Ulcerative  Stomatitis. 

1.  Begins  on  the  gums. 

2.  Local  symptoms. 

3.  Disease  develops  slowly. 

4.  Slow  ulceration. 

5.  No  discoloration  of  cheek. 

6.  Cheeks  but  little  swollen. 

7.  Salivation. 

Malignant  Pustule. 

1.  Begins  in  the  skin. 

2.  Constitutional    symptoms     severe 

from  the  first. 

3.  Breath  not  offensive. 

4.  No  bloody  discharge  from  mouth. 

5.  No  severe  pain. 

6.  No  enlarged  glands. 

Syphilitic  Ulceration  of  Tongue. 

1.  History  of  syphilis. 

2.  Usually  appears  on  dorsum. 

3.  Usually  multiple. 

4.  Progress  slow  and  not  very  painful. 


DISEASES  OF  THE  MOUTH  AND   THROAT. 


15 


NAME  OF  DISEASE. 

Cancer  of  Tongue. 

5.  Ganglionic  swelling. 

6.  Rare  before  middle  life. 

7.  Ulcer  has  indurated  base. 

8.  Microscope    shows    an     epithelial 

structure. 

9.  Medical  treatment  no  effect. 

True  Croup. 

1.  Begins   with    hoarseness    or    sore 

throat. 

2.  Advent  slow. 

3.  Temperature  high. 

4.  Exudation  fibrous. 

5.  Bronchial  symptoms.     , 

6.  Subsides  slowly. 

7.  Continued  cyanosis. 

8.  Aphonia  frequently  complete. 
g.   Change  in  voice. 

10.  Well-marked  constitutional  symp- 

toms. 

Acute  Laryngitis. 

1.  History  negative. 

2.  Fever. 

3.  Usually  a  disease  of  childhood. 

4.  Difficult  breathing,  both  inspiratory 

and  expiratory, 

5.  Brazen  or  croupous  cough. 

6.  Examination  shows   inflamed  mu- 

cous membrane. 

Acute  Laryngitis. 

1.  Peculiar  cough. 

2.  No  difficulty  in  swallowing. 


DISEASES  TO  BE  DIFFERENTIATED. 

Syphilitic  Ulceration  of  Tongue. 

5.  No  large  ganglionic  swelling. 

6.  Appears  at  any  age. 

7.  Ulcer  not  especially  indurated. 

8.  Microscope  shows  a  small-cell  infil- 

tration. 

9.  Medical  treatment  curative. 

False  Croup. 

1.  No  prodromata. 

2.  Advent  sudden. 

3.  Temperature  about  normal. 

4.  No  membranous  exudation. 

5.  Absence  of  lung  complications. 

6.  Disease  disappears  rapidly. 

7.  Cyanosis  of  short  duration. 

8.  Loss  of  voice  uncommon. 

9.  Voice  often  natural. 

10.   No     severe     constitutional    symp- 
toms ;  rarely  fatal. 

OEdema  Glottidis. 

1.  History  of  general  oedema — ulcers 

of  larynx  or  acute  disease,  etc. 

2.  Temperature  often  normal. 

3.  Usually  attacks  adults, 

4.  Inspiration  alone  affected, 

5.  Cough  not  croupous  in  character. 

6.  Examination  at  once   discloses  the 

oedematous  condition  of  the  larynx 

Retro-Pharyngeal    Abscess, 

1.  Cough  not  peculiar. 

2.  Dysphagia. 


i6 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Acute  Laryngitis. 

3.  No  stiffness  of  the  neck. 

4.  Brazen  voice. 

5.  Dyspnoea  relieved  by  throwing  the 

head  backward  or  by  horizontal 
position. 

6.  Dyspnoea  constant. 


7.  Examination  shows  presence  of  in- 
flamed mucous  membrane. 


DISEASES  TO  BE  DIFFERENTIATED. 

Retro-Pharyngeal  Abscess. 

3.  Neck  stiff  and  painful  on  motion 

or  pressure  along  spine, 

4.  Voice  guttural. 

5.  Dyspnoea      greatly     increased     by 

throwing  head  backward  or  by  the 
horizontal  position. 

6.  Dyspnoea  paroxysmal  and  brought 

on  by  swallowing  or  by  pressure 
on  larynx. 

7.  On  examination  a  fluctuating  pain- 

ful tumor  is  found  at  the  back 
part  of  pharynx. 


Acute  Laryngitis  (Croupous). 

See  Diphtheria,  page  20. 


Diphtheria. 


Chronic  Laryngitis. 

1.  Symptoms  appear  slowly. 

2.  Difficulty  in  breathing. 

3.  Cough  and  expectoration. 

4.  Symptoms  quite  constant. 

5.  Pain  in  larynx. 

6.  Laryngeal  examination  positive. 

Chronic  Laryngitis. 


Hysterical  Change  of  Voice. 

1.  Advent  sudden. 

2.  Absence  of  dyspnoea. 

3.  Cough  slight  and  without  expecto- 

ration. 

4.  Sudden  relief  of  symptoms. 

5.  No  pain  in  larynx. 

6.  Laryngoscopic    examination  nega- 

tive. 

Thoracic  Aneurism. 


See  Thoracic  Aneurism,  page  48. 

CEdema  Glottidis.  Acute  Laryngitis. 

See  Acute  Laryngitis,  page  15. 

CEdema  Glottidis.  Thoracic  Aneurism. 

See  Thoracic  Aneurism,  page  48. 


DISEASES  OF  THE  MOUTH  AND  THROAT. 


17 


NAME   OF    DISEASE. 

CEdema  Glottidis. 
CEdema  Glottidis. 


1.  History  of  general  oedema,  ulcer  of 

larynx,  acute  disease,  etc' 

2.  Dyspnoea  constant. 

3.  Dyspnoea  inspiratory  only. 

4.  Usually  attacks  adults. 

5.  Advent  sudden. 

6.  No  chills  or  sweating. 

7.  Dyspnoea    increased    by    bending 

head  forward. 

8.  Examination  shows  marked  oedema 

of  the  glottis. 


DISEASES  TO   BE  DIFFERENTIATED. 

Asthma. 

See  Asthma,  page  30. 

Retro-Pharyngeal  Abscess. 

I.   History  of  stiff  neck,  etc. 


2.  Dyspnoea  paroxysmal. 

3.  Dyspnoea  expiratory  and  inspira- 

tory. 

4.  Disease  especially  of  children. 

5.  Advent  gradual. 

6.  Fever,  chills,  and  sweating. 

7.  Dyspnoea    increased   by   throwing 

head  backward. 

8.  Examination    shows    presence    of 

a  post-pharyngeal  fluctuating  tu- 
mor. 


DIFFERENTIAL    DIAGNOSIS    OF    THE   DISEASES    OF 
THE  LUNGS  AND  PLEURA. 


DIFFERENTIAL    DIAGNOSIS    OF    THE    DISEASES    OV 
THE  LUNGS  AND  PLEURA. 


NAME    OF    DISEASE 


Pneumonia 


Broncho-pneumonia 


DISEASES  TO  BE  DIFFERENTIATED. 

Acute  pleurisy. 
Pleurisy  with  effusion. 
Broncho-pneumonia. 
Acute  phthisis. 

Pneumonia. 
Capillary  bronchitis. 
Acute  phthisis. 
Atelactasis. 


Acute  phthisis 


Chronic  phthisis 


Capillary  bronchitis  . 


Pneumonia. 
Broncho-pneumonia. 
Capillary  bronchitis. 
Abscess  of  lung. 

Chronic  bronchitis. 
Pulmonary  infarction. 
Cancer  of  lung. 
Broncho-pneumonia. 

r  Acute  catarrhal  bronchitis. 


j  Broncho-pneumonia. 


Acute  phthisis. 
^  CEdema  of  lungs. 


21 


22 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Chronic  bronchitis    . 
Gangrene  of  lung 
Cancer  of  lung 
Emphysema 


DISEASES  TO  BE  DIFFERENTIATED. 

j  Broncho-pneumonia. 
i  Chronic  phthisis. 

j  Abscess  of  lung. 
(  Fetid  bronchitis. 

j  Phthisis. 

t  Pleurisy  with  effusion. 

(  Pneumothorax, 
t  Asthma. 


Asthma    . 


Hemoptysis 


Acute  pleurisy 


Pleurisy  with  effusion 


Pneumothorax 


Empyema 


Spasmodic  affections  of  larynx. 

Emphysema. 

Angina  pectoris. 

5  Hematemesis. 
(  Epistaxis. 


(Acute  pericarditis 
Pneumonia. 
Intercostal  neuralgia. 
Perihepatitis. 

"  Pneumonia. 
Cancer  of  lung. 
Hydatids  of  lung. 
Hydro  thorax. 
Empyema. 

(  Phthisical  cavities. 
'  Emphysema. 


I  Pleurisy  with  effusion. 
<.  Abscess  of  liver. 
[  Thoracic  aneurism, 


DISEASES  OF  THE  LUNGS  AND  PLEURA. 


23 


NAME   OF   DISEASE. 

Pneumonia. 

1.  Begins  with  a  well-marked  chill. 

2.  Face  flushed  and  congested, 

3.  Temperature  from  104°  to  106^.' 

4.  Expectoration     rust-colored      and 

viscid. 

5.  Marked  dulness  upon  percussion. 

6.  Bronchial  voice  and  breathing. 

7.  Crepitant  rale  at  end  of  inspira- 

tion. 

Pneumonia. 

1.  Begins  with  a  marked  chill. 

2.  Face  flushed  and  mahogany  color. 

3.  Temperature  from  104°  to  106°. 

4.  Expectoration   rust  -  colored    and 

characteristic. 

5.  Breathmg  hurried  and  panting. 

6.  Dulness  on  percussion. 

7.  Bronchial  voice  and  respiration. 

8.  Heart  in  normal  position. 

9.  Crepitant  rale  at  end  of    inspira- 
tion. 

10,  Aspiration  negative. 

11.  Termination  by  crisis  about  sev- 

enth day. 

Pneumonia. 

1.  Begins  suddenly  with  a  chill. 

2.  Severe  pains  in  side, 

3.  Affects  one  lung, 

4.  Attacks  children  or  adults. 

5.  Bronchial  voice  and  breathing. 


DISEASES  TO  BE  DIFFERENTIATED. 

Acute  Pleurisy. 

1.  Begins  with  pain  in  side. 

2.  Face  pale  and  anxious. 

3.  Temperature  from  100°  to  102°. 

4.  Expectoration  frothy  and  mucous. 

5.  But  slight  dulness  on  percussion. 

6.  Feeble  voice  and  breathing. 

7.  Superficial  friction-sound  on  both 

expiration  and  inspiration. 

Pleurisy  with  Effusion. 

1.  Begins  with  chilly  sensations. 

2.  Face  pale  and  anxious. 

3.  Temperature  from  100 "^  to  102". 

4.  Expectoration  scanty  and  mucous. 

5.  Breathing  less  hurried  and  catch- 

ing. 

6.  Flatness  on  percussion,  but  changes 

with  position  of  patient. 

7.  Absence  of  voice  and  breathing. 

8.  Heart  displaced. 

9.  Absence  of  rales. 

10.  Aspiration  positive. 

11.  No  critical  days. 

Broncho-Pneumonia. 

1.  Begins  as  a  severe  bronchitis. 

2.  Stuffy  feeling  under  sternum. 

3.  Affects  both  lungs. 

4.  Usually  attacks  children. 

5.  Broncho-vesicular  voice  and  breath- 

ing. 


24 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE, 

Pneumonia. 

and 


6.  Dulness      unilateral      and       well 

marked. 

7.  Rales  crepitant  and  subcrepitant. 

8.  Terminates  by  crisis. 

Pneumonia. 

1.  Begins    with    chill    and    pain    in      i. 

side. 

2.  Affects  one  lung.  2. 

3.  Characteristic  pneumonic  sputum.        3. 

4.  Temperature   high  and  somewhat      4. 

remittent. 

5.  Face  flushed  and  mahogany  color.  5. 

6.  No  severe  sweating  until  crisis.  6. 

7.  Physical  signs  unilateral.  7. 

8.  Breathing  hurried  and  panting.  8. 

9.  Termination  by  crisis.  9. 


DISEASES  TO  BE  DIFFERENTIATED. 

Broncho-Pneumonia. 

6-.   Dulness  less  marked  and  bilateral. 

7.  Rales  subcrepitant  and  mucous. 

8.  Does  not  terminate  by  crisis. 


Acute  Phthisis. 

Begins  as  a  bronchitis  with  chilly 
feeling. 

Affects  both  lungs. 

Sputum  contains  bacilli  tubercu- 
losis. 

Temperature  irregular  and  inter- 
mittent. 

Face  has  a  hectic  appearance. 

Profuse  night  sweats. 

Physical  signs  bilateral. 

Respiration  hurried  but  natural. 

No  critical  days. 


Broncho-Pneumonia.  Pneumonia. 

See  Pneumonia,  page  23. 


Broncho-Pneumonia. 

1.  Often  a  secondary  disease. 

2.  Breathing  panting. 

3.  Temperature  high. 

4.  Dulness  on  percussion. 

5.  Respiratory  sounds  broncho-vesicu- 

lar. 

6.  Fine  rales  over  dull  areas. 


Capillary  Bronchitis. 

1.  Disease  primary. 

2.  Breathing  labored  and  hurried. 

3.  Temperature  not  so  high. 

4.  Exaggerated  pulmonary  resonance. 

5.  Respiratory  sounds  vesicular  and 

diminished. 

6.  Rales  uniform  all  over  chest. 


Broncho-Pneumonia. 

I.   Usually  a  disease  of  children. 


Acute  Phthisis. 

I.  Principally    a    disease    of    young 
adults. 


DISEASES  OF  THE  LUNGS  AND  PLEURA. 


25 


NAME   OF    DISEASE. 

Broncho-Pneumonia. 


DISEASES  TO  BE  DIFFERENTIATED. 

Phthisis. 


Breathing  panting  and  hurried.  2.   Breathing  quiet  and  hurried. 

Bronchitis   precedes    signs  of    con-  3.   Pyrexia  precedes  physical  signs. 

solidation. 

Emaciation  not  very  rapid.  4,  Very  rapid  exhaustion  and  emacia- 
tion. 

No  hemoptysis.  5.   Hemoptysis  common. 

No  bacilli  tuberculosis  in  sputum.  6.   Sputum  contains  many  bacilli. 

Physical    signs    most    marked     in  7.   Physical    signs    most    marked    at 

dependent      portion     of     lungs,  apices. 

usually. 
Sweating  not  excessive. 


Broncho-Pneumonia. 

Temperature  high. 

On  inspection  chest  appears  nor- 
mal. 

Diaphragm  in  normal  position. 

Respiratory  murmur  broncho-vesic- 
ular. 

Vocal  fremitus  increased. 

Rales  numerous  and  subcrepitant. 

Acute  Phthisis. 


8.  Profuse  sweating. 

Atelectasis. 

1.  Temperature  about  normal. 

2.  Chest-wall  retracted. 

3.  Diaphragm  elevated. 

4.  Respiratory  murmur  feeble. 

5.  Vocal  fremitus  diminished. 

6.  Rales  rare  in  collapsed  lung. 

Pneumonia. 


See  Pneumonia,  P^-ge  24. 
Acute  Phthisis.  Broncho-Pneumonia. 

See  Broncho-Pneumonia,  page  24. 


Acute  Phthisis. 


Capillary  Bronchitis. 


Temperature  very  high  and  inter-  i.   Temperature  less  high  and  remit- 

mittent.  .  tent. 

Profuse  sweats    and    chilly  sensa-  2.   No  marked  sweating  or  chilliness, 
tions. 


26 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF    DISEASE. 

Acute  Phthisis. 

3.  Emaciation  very  rapid. 

4.  Respiration  hurried  without  dysp- 

noea. 

5.  Bacilli  tuberculosis  in  sputum. 

6.  Dulness  on  percussion  at  apex, 

7.  Signs  of  lung  consolida,tion. 

8.  Rales  marked  at  apices. 

Acute  Phthisis. 

1.  High  temperature,  followed  usually 

at  night  with  profuse  sweats  and 
chilly  sensations. 

2.  Cough  and  expectoration   profuse 

from  the  beginning. 

3.  Expectoration  constant. 

4.  Expectoration     contains     tubercle 

bacilli. 

5.  Signs  of  cavity  develop  gradually. 

6.  No  sudden  improvement  of  patient. 


DISEASES   TO   BE   DIFFERENTIATED. 

Capillary  Bronchitis. 

3.  Emaciation  less  rapid. 

4.  Extreme  dyspnoea.. 

5.  No  bacilli  tuberculosis  in  sputum. 

6.  Exaggerated  pulmonary  resonance. 

7.  Lung  not  consolidated. 

8.  Rales  heard  all  over  chest. 

Abscess  of  Lung. 

T.   Chills,  followed  by  fever  and  sweat- 
ing. 

2.  Cough    and  expectoration  profuse 

after  rupture  of  abscess  into  bron- 
chii. 

3.  Sudden    expectoration   of   a   large 

amount  of  pus. 

4.  Sputum  contains  many  pus  cells. 

5.  Signs  of  cavity  develop  suddenly. 

6.  Patient    suddenly    improves    after 
discharge  of   the  abscess  into  bron- 

chii. 


Chronic  Phthisis. 

1.  Sputum   contains  bacilli    tubercu- 

losis. 

2.  Profuse  night  sweats. 

3.  Rapid  emaciation. 

4.  Hemoptysis  common. 

5.  Physical    signs    most    marked    at 

apices. 

6.  Dulness  on  percussion. 

7.  Rales  subcrepitant  and  sticky. 


Chronic  Bronchitis. 

1.  No  tubercle  bacilli  in  sputum. 

2.  No  profuse  sweats. 

3.  No  rapid  emaciation. 

4.  Hemoptysis  uncommon. 

5.  Physical     signs     not      limited     to 

apices. 

6.  No  dulness  on  percussion. 

7.  Rales  mucous  and  submucous. 


DISEASES  OF  THE  LUNGS  AND  PLEURA. 


27 


NAME    OF   DISEASE. 

Chronic    Phthisis. 

1.  Temperature  more  or  less  elevated. 

2.  Hemoptysis  a  bright  color. 

3.  Heart  usually  normal. 

4.  Sputum     contains  bacilli    tubercu- 

losis. 

5.  Symptoms  come  on  gradually. 

6.  Apices  chiefly  affected. 

Chronic  Phthisis. 

1.  Chest  retracted. 

2.  Pain  intermittent. 

3.  Patient  ansem.ic  and  hectic. 

4.  Disease  primary. 

5.  Expectoration  muco-purulent.    - 

6.  Temperature  elevated. 

7.  Sputum  contains  tubercle  bacilli. 

Chronic  Phthisis. 

1.  Attacks  any  one,  especially  adults. 

2.  Temperature    elevated,    especially 

3.  Sputum  contains  tubercle  bacilli, 

4.  Apices  principally  affected. 

5.  Hereditary. 

6.  Hemoptysis  common. 

7.  Frequent  signs  of  cavities  follow- 

ing those  of  consolidation. 

8.  Profuse  night  sweats. 

Capillary   Bronchitis. 

1.  Temperature  very  high. 

2.  Attacks  children  especially. 

3.  Extreme  dyspnoea. 


DISEASES   TO    BE   DIFFERENTIATED. 

Pulmonary  Infarction. 

I.   Temperature  nearly  normal. 
1.   Expectorated  blood  dark  and  co- 
agulated. 

3.  Advanced  valvular  heart  disease. 

4.  Sputum  free  from   bacilli  tubercu- 

losis. 

5.  Symptoms  appear  suddenly. 

6.  Lower  lobes  usually  affected. 

Cancer  of  Lung. 

1.  Chest  bulging. 

2.  Pain  constant. 

3.  Patient  cachectic. 

4.  Disease  secondary. 

5.  "  Currant-jelly  "  expectoration. 

6.  Temperature   normal     or    subnor- 

mal. 

7.  Sputum  contains  cancer  cells. 

Persistent  Broncho-Pneumonia. 

1.  Attacks  children  especially. 

2.  Temperature  nearly  normal. 

3.  No  tubercle  bacilli  in  sputum. 

4.  Apices  not  often  affected. 

5.  Not  hereditary. 

6.  No  hemoptysis. 

7.  No    signs     of     cavities     following 

those  of  consolidation. 

8.  No  profuse  sweating. 

Acute  Catarrhal  Bronchitis. 

1.  Temperature  but   moderately  ele- 

vated. 

2.  Attacks  any  one. 

3.  No  dyspnoea. 


28 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF  DISEASE. 

Capillary  Bronchitis. 

4.  Cyanosis  common. 

5.  Restless  and  feverisli. 

6.  Rales  sibilant  and  sonorous. 


DISEASES   TO    BE   DIFFERENTIATED. 

Acute  Catarrhal  Bronchitis. 

4.  No  cyanosis. 

5.  Patient  quiet  and  composed. 

6.  Rales  mucous  and  submucous. 


Capillary  Bronchitis.  Broncho-Pneumonia. 

See  Broncho- Pneumonia,  page  24. 

Capillary  Bronchitis.  Acute  Phthisis. 

See  Acute  Phthisis,  page  26. 


Capillary   Bronchitis. 

Temperature  elevated. 
Expectoration  tenacious. 
Disease  primary. 
Exaggerated  pulmonary  resonance. 

Chronic  Bronchitis. 


CEdema  of  the  Lungs. 

1.  Temperature  normal. 

2.  Expectoration  frothy  and  watery. 

3.  Secondary  disease^ 

4.  Dulness  on  percussion. 

Chronic  Phthisis. 


See  Chronic  Phthisis,  page  26. 


Chronic  Bronchitis. 

No  dyspnoea  if  uncomplicated. 

No  lung  consolidation. 
Usually  attacks  adults. 
Vocal  fremitus  normal. 
Rales  mucous  and  submucous. 
Frequent   formation  of  bronchiec- 
tatic  cavities. 


Gangrene  of  Lung. 

1.  Sputum  contains  pulmonary  tissue. 

2.  Unilateral  disease.  ' 

3.  Patient  greatly  prostrated. 

4.  Fever,  septic  or  hectic  in  character. 

5.  Signs  of  pulmonary  consolidation. 


Persistent  Broncho-Pneumonia. 

1.  Dyspnoea,    especially     upon   exer- 

tion. 

2.  Lung  consolidated. 

3.  Disease  of  children  especially. 

4.  Vocal  fremitus  exaggerated. 

5.  Subcrepitant  rales. 

6.  Lung  remains  consolidated. 

Fetid  Bronchitis. 

1.  No  pulmonary  tissue  in  sputum. 

2.  Disease  affects  both  lungs. 

3.  No  marked  prostration. 

4.  Temperature  normal. 

5.  Bronchiectatic  cavities  quite  com- 

mon. 


DISEASES  OF  THE  LUNGS  AND  PLEURA. 


29 


NAME   OF   DISEASE. 

Gangrene  of  Lung. 

1.  Signs  of  cavity  follow  fetid  expec- 

toration. 

2.  Sputum  a  dirty  black  color. 

3.  Sputum  contains  lung  tissue. 

4.  Fetor  has  a  putrefactive  smell. 

Cancer  of  Lung. 


DISEASES   TO   BE    DIFFERENTIATED. 

Fetid  Abscess  of  Lung. 

1.  Signs  of  cavity  precede  the   fetid 

expectoration. 

2.  Sputum  purulent. 

3.  Sputum   contains     numerous   pus- 

cells. 

4.  Fetor  has  a  sweetish  odor. 

Chronic  Phthisis, 


See  Chronic  Phthisis,  page  27. 


Cancer  of  Lung. 

1.  Usually  secondary. 

2.  Cancerous  cachexia. 

3.  Dulness   most   marked  above  and 

in  front. 

4.  Dulness  stationary. 

5.  Areas  of  resonance  throughout  the 

dull  portion  of  the  lung. 

6.  Friction  sound  over  area  of  dumess. 

Emphysema. 

1.  Symptoms  come  on  gradually. 

2.  Dyspnoea  paroxysmal  and  increased 

upon  exercise. 

3.  Disease  bilateral. 

4.  Percussion      sound     vesiculo-tym- 

panitic. 

5.  Breathing  vesicular. 

6.  Expiration     prolonged     and    low- 

pitched. 

Emphysema. 

I.  Vesiculo  -  tympanitic       percussion 
note. 


Pleurisy  with  Effusion. 

1.  Usually  primary. 

2.  Anaemia,  but  no  cachexia. 

3.  Dulness  most  marked  behind  and 

below. 

4.  Dulness  changes  with  position  of 

patient. 

5.  Uniform  dulness  or  flatness  below 

level  of  fluid. 

6.  Absence  of  sound  over  flat  area. 

Pneumothorax. 

1.  Begins  suddenly. 

2.  Dyspnoea  constant. 

3.  Disease  unilateral. 

4.  Percussion  note  tympanitic. 

5.  Breathing  amphoric  if  audible. 

6.  Expiratory  sounds  usually  absent. 

Bronchial  Asthma. 

I.  Percussion  note  exaggerated. 


30 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF   DISEASE. 

Emphysema. 

2.  Prolonged  low-pitched  expiration. 

3.  Always  dyspnoea  on  exertion. 
4-   Chest  barrel-shaped. 

5.  Heart  displaced. 

6.  Disease  constant. 

7.  Rales  few  in  number,  unless  there 

is   complicating    bronchitis,    and 
then  mucous  and  submucous. 

Bronchial  Asthma. 

1.  No  change  in  voice. 

2.  Cough  expulsive. 

3.  Dyspnoea  expiratory. 

4.  Numerous   sibilant    and  sonorous 

rales  in  chest. 

5.  Ausculatory   signs    negative    over 

larynx. 

6.  Laryngoscopic  examination   nega- 

tive. 


Bronchial  Asthma. 

No  pain  in  region  of  heart. 
Pulse  normal  in  regularity. 
Great  difficulty  in  breathing. 
Many  sibilant  and  sonorous  rales 
in  chest. 


DISEASES    TO    BE   DIFFERENTIATED. 

Bronchial  Asthma. 

2.  Expiration  never  low-pitched. 

3.  Dyspnoea  only  during  the  attack. 

4.  Shape  of  chest  normal. 

5.  Heart  not  displaced. 

6.  Attacks  purely  paroxysmal. 

7.  Many  sibilant  and  sonorous  rales 

heard  all  over  chest  during  attack. 

Spasmodic  Affections  of  Larynx. 

1.  Voice  much  altered. 

2.  Cough  and  breathing  stridulous. 

3.  Dyspnoea  inspiratory. 

4.  Absence  of  chest  rales. 

5.  Ausculatory    signs     positive    over 

larynx. 

6.  Laryngoscopic   examination   often 

positive. 

Angina  Pectoris. 

1.  Lancinating  pain  around  heart. 

2.  Pulse  intermittent  and  irregular. 

3.  Patient  tries  not  to  breathe  deeply. 

4.  Absence  of  chest  rales. 


Bronchial  Asthma.  Emphysema. 

See  Emphysema,  page  29. 


Hemoptysis. 


1.  Blood  liquid,  bright,  and  frothy. 

2.  Blood  free  from  foreign  matter. 

3.  Sinks  in  water  slowly. 


Hematemesis. 

1.  Blood  dark  and  coagulated, 

2.  Mixed  with  food  and  bile. 

3.  Sinks  in  water  rapidly. 


DISEASES  OF  THE  LUNGS  AND  PLEURA. 


31 


NAME   OF    DISEASE. 

Hemoptysis. 

4.  Alkaline  in  reaction. 

5.  Preceded  by  cough  and  other  chest 

symptoms. 

6.  History  of  lung  trouble. 

7.  Hemorrhage     followed    by    great 

prostration  and  irritable  cough. 

8.  Moist  rales  in  chest. 

Hemoptysis. 

1.  Blood  bright,  frothy,  and  fluid. 

2.  Attended  and  followed  by  cough. 

3.  History  of  lung  disease. 

4.  Moist  rales  in  chest. 

5.  Examination  of  nares  and  pharynx 

negative. 

6.  Great  prostration. 


DISEASES    TO    BE    DIFFERENTIATED. 

Hematemesis. 

4.  Acid  in  reaction, 

5.  Preceded  by  vomiting  and  pain  in 

stomach. 

6.  History  of  gastric  disturbance. 

7.  Not   followed   by  cough   or   great 

prostration. 

8.  Absence  of  chest  rales. 

Epistaxis. 

1.  Blood  coagulated  and  dark. 

2.  No  cough. 

3.  No  history  of  lung  trouble. 

4.  Absence  of  chest  rales. 

5.  Examination  of  nares  and  pharynx 

positive. 

6.  No  great  prostration. 


Acute  Pleurisy.  Intercostal  Neuralgia. 

1.  Temperature  elevated.  i.  Temperature  normal. 

2.  No     tenderness    over     intercostal       2,  Intercostal  nerves  tender  upon  pres- 

nerves.  sure. 

3.  Pain  constant  and  localized.  3.   Pain  shooting  and  intermittent. 

4.  No  vomiting  or  herpetic  eruption.        4.  Vomiting  and  herpes  zoster   com- 

mon. 

5.  Friction  sound  heard  on  ausculta-       5.   No  friction  sound  heard  on  auscul- 

tion.  tation. 

Acute  Pleurisy.  Pneumonia. 

See  Pneumonia,  page  23. 

Acute  Pleurisy.  Acute  Pericarditis. 

See  Acute  Pericarditis,  page  39. 
Acute  Pleurisy.  Perihepatitis. 

See  Perihepatitis,  page  85. 


32 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE.  DISEASES   TO    EE    DIFFERENTIATED. 

Pleurisy  with  Effusion.  Pneumonia. 

See  Pneumonia,  page  23. 

Pleurisy  with  Effusion,  Cancer  of  Lung. 

See  Cancer  of  Lung,  page  29. 


Pleurisy  with  Effusion. 

1.  Begins   acutely  with  pain,  fever, 

etc. 

2.  Quite  rapid  emaciation  and  loss  of 

health. 

3.  Effusion  produced  rapidly. 

4.  Flatness    on    percussion    changes 

with  position  of  patient. 

5.  Fluid  obtained  by  puncture  con- 

tains no  hooklets. 

Pleurisy  with  Effusion. 

1.  Affects  one  side. 

2.  Primary  disease. 

3.  Temperature  elevated. 
.4.  Pain  in  side. 

5.  No  general  dropsy. 

Pleurisy  with  Effusion. 


Hydatids  of  Lung. 

1.  Begins  slowly  and  insidiously. 

2.  Health  but  slowly  undermined. 

3.  Effusion  forms  slowly. 

4.  Flatness  on  percussion  not   much 

changed  by  position  of  patient. 

5.  Fluid  contains  characteristic  hook- 

lets. 

Hydrothorax. 

1.  Affects  both  sides. 

2.  Secondary  disease. 

3.  Temperature  normal. 

4.  No  pain  in  side. 

5.  General  dropsy. 

Empyema. 


See  Empyema,  page  33. 


Pneumothorax. 


Emphysema. 


See  Emphysema,  page  29. 


Pneumothorax. 

1.  Developed  suddenly. 

2.  Severe  dyspnoea. 

3.  Bulging  of  intercostal  spaces. 

4.  Heart  displaced. 

5.  Vocal  fremitus  diminished  or  ab- 

sent. 


Phthisical  Cavities. 

1.  Developed  slowly. 

2.  Dyspnoea  not  severe. 

3.  Chest  wall  generally  retracted. 

4.  Heart  in  normal  position. 

5.  Vocal  fremitus  increased. 


DISEASES  OF  THE  LUNGS  AND  PLEURA. 


33 


NAME   OF   DISEASE. 

Pueumothorax. 

6.  Physical  signs  heard  all  over   af- 

fected side. 

7.  Succussion  of  fluid  is  present. 

8.  Absence  of  rales. 

Empyema  (pulsating). 


DISEASES   TO   BE   DIFFERENTIATED. 

Phthisical  Cavities. 

6.  Physical  signs  usually   limited   to 

apices. 

7.  No  succussion. 

8    Gurgling  rales  at  apices. 


Thoracic  Aneurism. 

See  Thoracic  Aneurism,  page  48. 
Empyema.  Abscess  of  Liver. 

See  Abscess  of  Liver,  page  80. 


Empyema. 

1.  Usually  a  history  of  previous  dis- 

ease, as  pleurisy,  phthisis,  general 
debility,  etc. 

2.  Constitutional      symptoms       well 

marked. 

3.  Temperature  often  reaches  105°. 

4.  Chills  and  profuse  sweats  common. 

5.  Fluid  remains   unless  it   is   with- 

drawn. 

6.  Exploring  needle  withdraws  pus. 

7.  Whispered  pectoriloquy  sometimes 

heard  below  the  level  of  the  fluid. 


Pleurisy  with  Effusion. 

1.  Histoiy  of  an  acute  attack  follow- 

ing exposure  to  wet  ,cold,  etc. 

2.  General    condition    remains   quite 

good. 

3.  Temperature  seldom  over  102°. 

4.  No  chills  or  sweats. 

5.  Fluid  disappears  under  appropriate 

medical  treatment. 

6.  Exploring  needle  withdraws  serum. 

7.  Absence  of  voice  sounds  below  the 

level  of  the  fluid. 


DIFFERENTIAL    DIAGNOSIS    OF    THE    DISEASES   OF 
THE    HEART    AND    BLOOD-VESSELS. 


DIFFERENTIAL    DIAGNOSIS    OF   THE    DISEASES    OF 
THE  HEART  AND  BLOOD-VESSELS. 


NAME    OF    DISEASE. 

Acute  pericarditis 

Endocarditis 
Ulcerative  endocarditis 

Cardiac  hypertrophy 

Fatty  heart 

Palpitation  of  heart  (nervous) 

Angina  pectoris 

Exophthalmic  goitre  . 


DISEASES    TO    BE   DIFFERENTIATED. 

Acute  endocarditis. 
Acute  pleurisy. 
Cardiac  enlargement. 

j  Acute  pericarditis. 

I  Functional  heart  murumrs. 

(  Typhoid  fever. 
I  Pyaemia. 

Cardiac  dilatation. 
Displacement  of  heart. 
Acute  pericarditis. 
Thoracic  aneurism. 
Consolidation  of  lung  tissue. 

Cardiac  dilatation. 

Organic  heart  disease. 

Bronchial  asthma. 
J  Hysteria. 

I  Intercostal  neuralgia. 
[  Thoracic  aneurism. 


Cystic  goitre  with  heart  disease. 


37 


38 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


CARDIAC    MURMURS. 


NAME   OF   DISEASE. 


Aortic  obstructive 


DISEASES   TO    BE   DIFFERENTIATED. 

'Mitral  regurgitation. 
Tricuspid  regurgitation. 
.    <  Anaemic  bruit. 

Thoracic  aneurism. 
Aortic  regurgitation. 


Aortic  regurgitation 


Aortic  obstructive. 
Mitral  obstructive. 
Pulmonary  regurgitation. 
Thoracic  aneurism. 


Mitral  obstructive 


Mitral  regurgitation. 
Aortic  regurgitation. 


Mitral  regurgitation 


Aortic  obstructive. 

Mitral  obstructive. 
Tricuspid  regurgitation. 


ANEURISMS. 


Abdominal  aneurisms 


Pulsation  of  aorta. 
Abdominal  tumors. 
Psoas  abscess. 


Thoracic  aneurism 


Aortic  obstructive. 
Aortic  regurgitation. 
Cancer  of  pleura. 
Chronic  laryngitis. 
Pulsating  empyema. 
Dilated  heart. 
Angina  pectoris. 


DISEASES  OF  THE  HEART  AND  BLOOD-VESSELS. 


39 


NAME   OF    DISEASE. 

Acute  Pericarditis. 

1.  Superficial  friction  sound. 

2.  Murmurs  have   limited   areas   of 

diffusion. 

3.  Murmurs  intensified  by  inclination 

of  body. 

4.  Murmurs  intensified  by  taking  a 

full  inspiration. 

5.  Murmurs  not  necessarily  synchro- 

nous with  the  heart-sounds. 

6.  Heart-impulse  wavy  and  feeble. 

7.  In  stage  of  effusion,  extended  peri- 

cordial  dulness. 

8.  Murmurs  disappear  with  the  effu- 

sion, to  return  again  with  the 
absorption  of  the  effusion. 

Acute  Pericarditis. 

1.  Pain  not  severe. 

2.  Pain  not  affected  by  respiration. 

3.  Pulse  feeble  and  irritable. 

4.  Friction  sound  constant  until  effu- 

sion takes  place. 

Acute  Pericarditis 

(with  effusion). 

1.  Disease  developed  suddenly. 

2.  There   is    or   has   been  a   friction 

sound  present. 

3.  OutHne  of  dulftess,  triangular. 

4.  Cardiac  dulness  extends  to  the  left 

of  apex  beat. 

5.  Heart-sounds  indistinct  and  feeble. 


DISEASES   TO    BE    DIFFERENTIATED. 

Acute  Endocarditis. 

1.  Deep  blowing  sound. 

2.  Murmurs    have     wide     areas     of 

diffusion. 

3.  Position   of  body  does  not  influ- 

ence the  intensity  of  the  mur- 
murs. 

4.  Murmurs    not  increased  in  loud- 

ness by  a  full  inspiration. 

5.  Murmurs    synchronous   vdth    the 

heart-sounds. 

6.  Heart-impulse  strong. 

7.  No    extended      pericordial     dul- 

ness. 

8.  Murmurs  constant. 


Acute  Pleurisy. 

1.  Pain  sharp  and  cutting. 

2.  Increased  by  inspiration. 

3.  Pulse  regular  and  strong. 

4.  Friction  sound    ceases  by  holding 

the  breath. 

Cardiac  Enlargement 

(hypertrophy  or  dilatation). 

1.  Disease  developed  slowly. 

2.  No  friction  sound. 

3.  Outline  of  dulness,  quadrilateral. 

4.  Dulness   does   not  extend  beyond 

apex  beat, 

5.  Heart -sounds    distinct,     however 

feeble  or  strong. 


40 


DIFI^ERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF    DISEASE. 

Endocarditis. 


DISEASES   TO    BE   DIFFERENTIATED. 

Acute  Pericarditis. 


See  Acute  Pericarditis,  page  39. 


Endocarditis. 

1.  Signs  of  obstructed  circulation. 

2.  Cardiac  hypertrophy  or  dilatation. 

3.  Patient  often  robust. 

4.  Murmurs  most  frequent  at  apex. 

5.  Murmurs  constant. 

60  Murmurs  do  not  disappear  under 
treatment. 

Ulcerative  Endocarditis. 

1.  Often  rheumatic  origin. 

2.  Temperature  fluctuating. 

3.  Disease  develops  rapidly. 

4.  Cardiac  murmurs  present. 

5.  Frequent  signs  of  embolus. 

6.  Petechial  eruption  on  body. 

7.  No  characteristic  diarrhoea  or  nose- 

bleed. 

Ulcerative  Endocarditis. 

1.  Often  of  rheumatic  origin. 

2.  Cardiac  murmurs  present. 

3.  Confusion  of  mind  followed  by  de- 

lirium 

4.  Petechial  eruption. 

5.  Sour  breath 

Cardiac  Hypertrophy. 

1.  Pulse  full  and  bounding, 

2.  Face  flushed. 


Functional  Heart  Murmurs. 

1.  No  obstructed  circulation. 

2.  No  cardiac  enlargement. 

3.  Patient  anaemic  and  feeble. 

4.  Murmurs  most  frequent  at  base. 

5.  Murmurs  intermittent. 

6.  Murmurs  disappear  under  appro- 

priate treatment. 

Typhoid  Fever. 

1.  No  history  of  rheumatism. 

2.  Weekly     characteristic      tempera- 

tures. 

3.  Disease  develops  slowly. 

4.  No  cardiac  murmurs. 

5.  Signs  of  emboli  uncommon. 

6.  Rose-colored    lenticular    spots   on 

abdomen. 

7.  Characteristic  diarrhoea  and  nose- 

bleed. 

Pyaemia. 

1.  History  of  surgical  injury,  or  dis- 

ease. 

2.  No  cardiac  murmurs. 

3.  Mind  at  first  clear,  and  then  fol 

lowed  by  stupor. 

4.  Skin  deeply  jaundiced. 

5.  Sweet  breath. 

Cardiac  Dilatation. 

1.  Pulse  weak  and  feeble. 

2.  Face  pale  and  livid. 


DISEASES  OF  THE  HEART  AND  BLOOD-VESSELS. 


41 


NAME   OF    DISEASE. 

Cardiac  Hypertrophy. 

Beating  carotids. 


4.  Apex-beat  distinct  and  forcible. 

5.  Heart-sounds  intensified. 

6.  First  sound  prolonged  and  intensi- 

fied. 

Cardiac  Hypertrophy. 

1.  Subjective   symptoms,  as  cerebral 

hypersemia. 

2.  Heaving  cardiac  impulse. 

3.  Increase   of    area  of    cardiac    dul- 

ness. 

4.  Change  in  character  and  intensity 

of  heart-sounds. 

Cardiac  Hypertrophy. 


disf:ases  to  be  differentiated. 
Cardiac  Dilatation. 

3.  Veins  turgid. 

4.  Apex-beat  indistinct  and  feeble. 

5.  Heart-sounds  enfeebled. 

6.  First   sound  indistinct,  short,  and 

resembles  the  second  sound. 

Displacement  of  Heart. 

No  subjective  heart-symptoms. 


Cardiac  impulse  normal. 
No  increase  of  heart-dulness. 


4.   Normal  heart-sounds. 


Acute  Pericarditis. 


See  Acute  Pericarditis,  page  39. 


Cardiac  Hypertrophy. 

1.  No  pain  in  the  back. 

2.  No  dysphagia. 

3.  Face  flushed,  cerebral  hypersemia. 

4.  Area  of    heart  -  dulness   increased 

laterally  and  downward. 

5.  Heaving  cardiac  impulse. 

6.  No  thrill  or  bruit. 

Cardiac  Hypertrophy 

1.  Pulse  full  and  tense. 

2.  Altered  first  sound. 

3.  Outline  of  cardiac  dulness,  quadri- 

lateral. 

4.  No  bronchial  voice  or  breathing. 

5.  Absence  of  rales. 


Thoracic  Aneurism. 


1.  Boring  pain  in  dorsal  spine. 

2.  Dysphagia  common. 

3.  Face  pale  or  lirid — cerebral  con- 

gestion. 

4.  Heart-dulness  increased  upward. 


5.  Impulse,  dilating. 

6.  Aneurismal  thrill  and  bruit. 

Consolidation  of  Lung  Tissue. 

1.  Pulse  weak. 

2.  Heart's  sound  normal. 

3.  Outline  of  dulness,  irregular. 

4.  Bronchial  voice  and  breathing. 

5.  Moist  rales. 


42 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF    DISEASE. 

Fatty  Heart. 

1.  Pulse  irregular. 

2.  Area  of  dulness  not  increased. 

3.  Absence  of  first  sound. 

4.  No  cardiac  murmur. 

5.  Cheyne-Stokes  respiration. 

6.  Marked  cerebral  symptoms. 

Organic  Heart  Disease. 

(Cardiac  palpitation.) 

1.  Comes  on  gradually. 

2.  Causes,  rheumatism,  syphilis,  etc. 

3.  No  distinct  paroxysms. 

4.  Increased  by  exercise. 

5.  Patient  not  uneasy  or  worried. 

6.  Often  accompanied  by  cyanosis. 

7.  Cardiac  murmurs  present. 


Angina  Pectoris. 

See  Bronchial  Asthma,  page  30 


DISEASES    TO   BE   DIFFERENTIATED. 

Dilatation  of  Heart. 

1.  Pulse  regular. 

2.  Area  of  dulness  increased. 

3.  Enfeebled  first  sound. 

4.  Cardiac  murmurs  common. 

5.  Respiration  normal,  or  hurried. 

6.  No  cerebral  symptoms.  ^ 

Functional  Heart  Disease. 

(Cardiac  palpitation.) 

1.  Comes  on  suddenly. 

2.  Causes,   emotion,   indigestion,    to- 

bacco, etc. 

3.  Distinctly  paroxysmal. 

4.  Increased  by  a  sedentary  life. 

5.  Patient  very  uneasy  and  worried. 

6.  No  cyanosis. 

7.  No  cardiac  murmurs. 

Bronchial  Asthma. 


Angina  Pectoris. 

1.  Lancinating  pain  in  side. 

2.  Pulse  feeble  and  irregular. 

3.  Patient  conscious  and  quiet. 

4.  History  of  cardiac  disease. 

5.  Cardiac  murmurs  present. 

Angina  Pectoris. 

1.  History  of  cardiac  disease. 

2.  Attack  quickly  over. 

3.  No  external  tenderness. 

4.  Pain  unilateral. 


Hysteria. 

1.  Globus  hysteria. 

2.  Pulse  strong  and  regular. 

3.  Patient  has  convulsions  and  semi- 
coma. 

4.  History  of  hysteria. 

5.  No  cardiac  murmurs. 

Intercostal  Neuralgia. 

1.  History  of  neuralgic  attacks. 

2.  Attack  lasts  for  some  time. 

3.  Marked  external  tenderness. 

4.  Pain  often  bilateral. 


DISEASES  OF  THE  HEART  AND  BLOOD-VESSELS. 


43 


NAME  OF  DISEASE. 

Angina  Pectoris. 

5.  Cardiac    disturbance — feeble    and 

irregular  action  of  heart. 

6.  No  herpetic  eruption   follows  the 

attack. 

Angina  Pectoris. 

1.  Pain  referred  to  front  of  chest. 

2.  Pain  paroxysmal  and  lancinating. 

3.  Pulse  irregular  and  intermittent. 

4.  Heart  diseased. 

5.  No  thoracic  pulsating  tumor. 

6.  Respiration  shallow  and  catching. 

Exophthalmic  Goitre. 

1.  Paroxysmal   enlargement    of    dis- 

eased thyroid  gland. 

2.  Thyroid  very  elastic. 

3.  Eyes  have  lustrous  appearance  and 

marked  by  exophthalmus. 

4.  No  cardiac  murmur. 

5.  Cardiac  palpitation  paroxysmal. 

Aortic  Obstruction. 

1 .  Pulse  hard  and  wiry  but  regular. 

2.  Subjective  symptoms  are  cerebral 

in  character. 

3.  Murmur  harsh. 

4.  Loudest  at  base. 

5.  Conveyed  into  vessels  of  neck. 

6.  Pulmonic  second  sound  feeble. 


DISEASES  TO  BE  DIFFERENTIATED. 

Intercostal  Neuralgia. 

5.  Heart  normal. 

6.  Attack    often    followed  by  herpes 

zoster. 

Thoracic  Aneurism. 

1.  Pain  referred  to  back. 

2.  Pain  quite  constant  and  boring. 

3.  Pulse  regular,  but  often  unlike  at 

the  wrists. 

4.  Heart  normal. 

5.  Pulsating  thoracic  tumor. 

6.  Respiration  hurried  and  difficult. 

Cystic  Goitre  with  Cardiac  Dis- 
ease. 

1.  Thyroid  remains  enlarged  without 

fluctuating  in  size. 

2.  Thyroid  less  elastic. 

3.  Eyes  have  a  dull  appearance  with- 

out great  exophthalmus. 

4.  Cardiac  murmurs  present. 

6.   Palpitation  of  the  heart  not  strict- 
ly paroxysmal. 

Mitral  Regurgitation. 

1.  Pulse  compressible  and  irregular. 

2.  Subjective  symptoms  are  pulmon- 

ary, renal,  interstitial,  etc. 

3.  Murmur  soft. 

4.  Loudest  at  apex. 

5.  Conveyed  to  the  left  and  behind. 
6.    Pulmonic    second    sound    intensi- 
fied. 


44 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE. 

Aortic  Obstruction. 

1.  No  venous  pulsation. 

2.  Hypertrophy  of  left  heart. 

3.  Murmur    heard  loudest  at  second 

costo-sternal  articulation. 

4.  Conveyed  upward  into  carotids. 

Aortic  Obstruction. 

1.  Pulse  hard  and  wiry. 

2.  Patient  often  robust. 

3.  Cardiac  hypertrophy. 

4.  Murmurs  loudest  over  base. 

5.  Murmur  harsh  in  character. 

6.  No  venous  hum. 

Aortic  Obstruction. 

1.  No  pain. 

2.  Having  apical  impulse. 

3.  No  dilating  impulse  oii  palpitation. 

4.  Bruit  single. 

5.  Pulse  the  same  at  both  wrists. 

6.  Sphygmographic    ^tracings      diag- 

nostic. 

7.  No  laryngeal  or,  oesophageal   sub- 

jective symptoms. 

Aortic  Obstruction. 

1.  Hard,  small  wiry  pulse. 

2.  Systolic  murmur. 

3.  Conveyed  upward  into  carotids. 

4.  No  capillary  pulsation. 

Aortic  Regurgitation. 

I,  No  well  marked  pulmonary  symp- 
tons. 


DISEASES  TO  BE  DIFFERENTIATED. 

Tricuspid  Regurgitation. 

1.  Pulsation  of  jugular. 

2.  Hypertrophy  of  right  heart. 

3.  Murmur  heard  loudest  over  lower 

part  of  sternum. 

4.  Murmur   seldom  heard   above  the 

third  rib. 

Anaemic  Bruit. 

1.  Pulse  soft  and  compressible. 

2.  Patient  always  anaemic. 

3.  Small  heart. 

4.  Murmur  loudest  in  carotids. 

5.  Murmur  soft  and  blowing. 

6.  Loud  venous  hum. 

Thoracic  Aneurism. 

1.  Boring  pain  in  back  and  chest. 

2.  Normal  apical  impulse. 

3.  Dilating  impulse  over  aneurism. 

4.  Bruit  double. 

5.  Pulse    often   different  at   the    two 

wrists. 

6.  Sphygmographic      tracings     often 

differ  at  the  wrists. 

7.  Subjective    laryngeal  and  oesopha- 

geal symptoms  common. 

Aortic  Regurgitation. 

1.  "  Shot"  pulse. 

2.  Murmur  diastolic. 

3.  Conveyed  downward  to  xiphoid. 

4.  Capillary  pulsation. 

Mitral  Obstruction. 

I,  Pulmonary  symptoms  well  marked 
upon  exercise. 


DISEASES  OF  THE  HEART  AND  BLOOD-VESSELS. 


45 


NAME  OF  DISEASE. 

Aortic  Regurgitation. 

2.  "  Shot  "  pulse. 

3.  Capillary  pulsation  seen  at  fundus, 

of  eye  and  under  nails. 

4.  Murmur  diastolic. 

5.  Murmur  soft  and  musical. 

6.  Murmur  very  diffuse. 

7.  No  purring  thrill. 

8.  Left  ventricle  hypertrophied. 

Aortic  Regurgitation. 


"Shot"  pulse. 

Capillary  pulsation. 

Left  ventricle  hypertrophied. 

Murmur  heard  with  maximum  in- 
tensity, at  right  second  intercostal 
space,  or  at  xiphoid  cartilage. 

Aortic  Regurgitation. 


"  Shot  "pulse. 

Capillary  pulsation. 

Cardiac  hypertrophy. 

Diastolic  murmur. 

Murmur  transmitted  downward. 


DISEASES  TO  BE  DIFFERENTIATED. 

Mitral  Obstruction. 

2.  Pulse  soft  and  full. 

3.  No  capillary  pulsation. 

4.  Murmur  presystolic. 

5.  Murmur  grating  and  blubbering. 

6.  Murmur  limited. 

7.  Purring  thrill. 

8.  No  ventricular  hypertrophy. 

Pulmonary  Regurgitation. 

1.  Pulse  soft. 

2.  No  capillary  pulsation. 

3.  Right  ventricle  hypertrophied. 

4.  Murmur  heaid  with  greatest  inten- 

sity at  the  left  second  intercostal 
space. 

Thoracic  Aneurism. 

(Sinus  of  valsalva.) 

1.  Pulse  feeble  and  compressible. 

2.  No  capillary  pulsation. 

3.  Cardiac  degeneration. 

4.  Systolic  aneurismal  murmur. 

5.  Murmur  never  transmitted  toward 

apex. 

Aortic  Obstruction. 


Aortic  Regurgitation. 

See  Aortic  Obstruction,  page  44. 
Mitral  Obstruction.  Aortic  Regurgitation. 

See  Aortic  Regurgitation,  page  44. 

Mitral  Obstruction.  Mitral  Regurgitation. 

Murmur  diastolic.  i.   Murmur  presystolic. 

2.   Conveyed  around  to  the  back. 


Murmur  of  limited  area. 


46 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE. 

Mitral  Obstruction. 

3.  Murmur  blubbering  in  character. 

4.  Heard  loudest  above  apex. 

5.  Purring  thrill. 

Mitral  Regurgitation. 


DISEASES  TO  BE  DIFFERENTIATED. 

Mitral  Regurgitation. 

3.  Murmur  soft  and  blowing. 

4.  Heard  loudest  at  apex. 

5.  No  thrill. 

Aortic  Obstruction. 


See  Aortic  Obstruction^  pa-ge  43. 

Mitral  Regurgitation.  Mitral  Obstruction. 

See  Mitral  Obstruction,  page  45. 


Mitral  Regurgitation. 

1.  Pulmonary  symptoms  prominent. 

3.  Murmur  loudest  at  apex. 

2.  Murmur  conveyed  to  the  left. 

4.  Pulmonary  second    sound  intensi- 

fied. 

5.  No  venous  pulsation. 

Abdominal  Aneurism. 

1.  Deep    boring    pain   in   back  and 

shooting  down  the  thighs. 

2.  Throbbing  localized  in  a  pulsating 

tumor. 

3.  Expansive  pulsation  of  tumor. 

4.  Double  murmur. 

5.  Marked  thrill. 

Abdominal  Aneurism. 

1.  Health  good. 

2.  Tumor  has  an  expansive  pulsation. 

3.  Impulse   not    lessened    by   knee- 

chest  position. 

4.  Tumor  not  movable. 


Tricuspid  Regurgitation. 

1.  No  pulmonary  symptoms. 

2.  Murmur  loudest  near  xiphoid. 

3.  Transmitted   upward   and   to  the 

right. 

4.  Pulmonary  second  sound  infeebled. 

5.  Jugular  pulsation. 

Pulsating  Aorta. 

1.  Absence  of  pain. 

2.  Throbbing  felt  along  whole  course 

of  the  aorta. 

3.  Pulsation  sudden  and  jerky. 

4.  No  murmur. 

5.  No  thrill. 

Pulsating  Abdominal  Tumors. 

1.  General  health  poor. 

2.  Tumor  has  a  foru^ard  pulsation. 

3.  Impulse    lessened  by    the    knee- 

chest  position. 

4.  Tumor  usually  movable. 


DISEASES  OF  THE  HEART  AND  BLOOD-VESSELS. 


47 


NAME  OF  DISEASE. 

Abdominal  Aneurism. 

%    Boring  pain,  and  darting  down  the 
thighs. 

6.  Marked  thrill. 

7.  Double  murmur. 

Abdominal  Aneurism. 

1.  Disease  of  spine  secondary. 

2.  Expansive  pulsating  tumor. 

3.  Well  marked  thrill. 

4.  Double  murmur. 

5.  No  fluctuation. 

6.  No  difficulty  in  walking. 

7.  Temperature  normal. 

Thoracic  Aneurism. 


DISEASES  TO  BE  DIFFERE:NTIATED. 

Pulsating  Abdominal  Tumors. 

5.  Pain  usually  dull  and  not  neuralgic 

in  character. 

6.  No  thrill. 

7.  No  murmur — if  any,  single. 

Psoas  Abscess. 

1.  Disease  of  spine  primary. 

2.  No  expansive  pulsating  tumor. 

3.  No  thrill. 

4.  No  murmur. 

5.  Deep  fluctuation. 

6.  Often   great   difficulty   in  walking 

due  to  pain  and  flexion  of  thigh. 

7.  Temperature  often  elevated. 

Aortic   Obstruction. 


.5V,?  Aortic   Obstruction,  page  44. 

Thoracic  Aneurism.  Aortic  Regurgitation. 

See  Aortic  Regurgitation,  page  44. 

Thoracic  Aneurism.  Cardiac  Hypertrophy. 

See  Cardiac  Hypertrophy,  page  41. 

Thoracic  Aneurism.  Angina   Pectoris. 

See  Angina  Pectoris,  page  43. 

Thoracic  Aneurism. 

Not  hereditary,  or  secondary. 
Pain  wandering  and  not  constant. 
Pain  increased  by  excited  heart's 


action. 

4.  Pulse  at  two  wrists  often  unlike. 

5.  No  enlarged  glands  in  neck  or  ax- 

illa. 


Cancer   of  Pleura. 

1.  Hereditary  or  secondary. 

2.  Pain  constant. 

3.  Pain   not  increased  by  over-action 

of  the  heart. 

4.  Pulse  at  the  wrists  alike. 

5.  Enlarged     cervical     and     axillary 

veins  and  glands. 


48 


DISEASES  OF  THE  HEART  AND  BLOOD-VESSELS. 


NAME    OF    DISEASE. 

Thoracic  Aneurism. 

6.  Expansive  pulsation. 

7.  Double  murmur. 

8.  Well-marked  thrill. 

g.   Subjective  sense  of  throbbing. 

Thoracic   Aneurism. 

1.  Pain  wandering. 

2.  No  chills,  fever,  or  sweating. 

3.  Heart  in  normal  position. 

4.  Double  murmur. 

5.  Well-marked  thrill. 

6.  Exploring  needle  withdraws  blood. 

Thoracic  Aneurism. 

1.  Pain  in  chest. 

2.  Pulsating  tumor  in  chest. 

3.  Double  murmur  and  thrill. 

4.  Cough,  paroxysmal  and  ringing. 

5.  Voice    not   unifonnly    changed   in 

character. 

6.  Stridulous    voice    and      breathing 

come  on  suddenly  and  are  parox- 
ysmal. 

7.  Laryngoscopic  examination  shows 

spasm  of  vocal  cords. 


DISEASES    TO    BE    DIFFERENTIATED. 

Cancer  of  Pleura. 

6.  No  expansive  pulsation. 

7.  No  double  murmur. 

8.  No  thrill. 

9.  No  throbbing  sensations. 

Pulsating   Empyema. 

1.  Pain  stationary. 

2.  Chills,  fever,  and  sweating. 

3.  Heart  pushed  to  one  side. 

4.  No  murmur. 

5.  No  thrill. 

6.  Exploring  needle  withdraws  pus. 

Chronic   Laryngitis. 

1.  Pain  referred  to  larynx. 

2.  No  tumor  in  chest. 

3.  No  murmur  or  thrill. 

4.  Cough  more   constant  and  stridu- 

lous. 

5.  Voice  always  changed. 

6.  Change  in  voice  and  breathing  less 

paroxysmal  in  character. 

7.  Laryngeal  examination  shows  dis- 

ease of  larynx. 


DIFFERENTIAL   DIAGNOSIS    OF    THE   DISEASES   OF 
THE   DIGESTIVE   TRACT   AND    PERITONEUM. 


DIFFERENTIAL   DIAGNOSIS   OF    THE    DISEASES   OF 
THE    DIGESTIVE    TRACT    AND    PERITONEUM. 


NAME    OF   DISEASE. 

Cancer  of  the  oesophagus    . 
Acute  gastritis    . 

Toxic  gastritis    . 

Chronic  gastritis 
Gastric  dyspepsia 

Cancer  of  stomach 
Ulcer  of  stomach 


DISEASES   TO    BE   DIFFERENTIATED. 

Organic  stricture. 
Hysterical  stricture. 

Toxic  gastritis. 
Acute  peritonitis. 

'Acute  gastritis. 

Acute  peritonitis. 

Acute  enteritis. 

Cholera  morbus. 
^  Cholera. 

I  Dyspepsia. 
-I  Ulcer  of  stomach. 
I  Cancer  of  stomach. 

I  Chronic  gastritis. 

<  Acid  fermentation. 
I  Cerebral  vertigo. 

Chronic  gastritis. 
Ulcer  of  stomach. 
Abdominal  aneurism. 
Cancer  of  liver. 

I  Chronic  gastritis. 

<  Cancer  of  stomach. 
I  Cardialgia. 

51 


52 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF    DISEASE. 

Hematemesis 

Acute  enteritis  . 

Cholera  morbus 

Cholera  infantum 
Dysentery. 

Perityphlitis 


Intestinal  obstruction 


Tubercular  enteritis 


Cancer  of  intestine 


Proctitis 


DISEASES   TO    BE   DIFFERENTIATED, 

Hemoptysis. 
Acute  poisoning. 
Acute  peritonitis. 
Cholera  morbus. 
Typhoid  fever. 

Acute  enteritis. 
Asiatic  cholera. 
Acute  poisoning. 

Enteritis  of  children. 
Hydrocephalus. 

Diarrhoea  with  hemorrhoids. 
Proctitis. 

Cancer  of  rectum. 
Typhlitis. 
Cancer  of  caecum. 
Distension  of  caecum. 
Psoas  abscess. 
Intussusception. 

Intestinal  colic. 
Peritonitis. 
Hepatic  colic. 
Renal  colic. 
Chronic  constipation. 

Tubercular  meningitis. 
Tubercular  peritonitis, 

Floating  kidney. 
Proctitis. 
Perityphlitis. 
[  Hemorrhoids. 

Periproctitis. 
Cancer  of  intestine. 
Dysentery, 
Hemorrhoids. 


DISEASES  OF  DIGESTIVE  TRACT  AND  PERITONEUM.     53 


NAME   OF  DISEASE. 


Hemorrhoids 


Intestinal  colic  . 


Acute  peritonitis 


Chronic  peritonitis 


Tuberculous  peritonitis 


Ascites 


Cancer  of  CEsophagus. 

1.  History  of  hereditary  cancer. 

2.  Pain  constant. 


DISEASES    TO    BE   DIFFERENTIATED. 

Proctitis. 
Dysentery. 
Cancer  of  rectum. 
Intestinal  hemorrhage. 

Acute  peritonitis. 
Intestinal  obstruction. 
Hepatic  colic.        ., 
Renal  colic. 
Intestinal  perforation. 
Muscular  rheumatism. 
Uterine  colic. 

Acute  enteritis. 

Intestinal  colic. 

Hysteria. 

Renal  or  hepatic  colic. 

Acute  gastritis. 

Intestinal  obstruction. 

Acute  poisoning. 

Tuberculous  peritonitis. 
Cancerous  peritonitis. 
Ascites. 

Cancer  of  peritoneum. 
Chronic  peritonitis. 
Tubercular  enteritis. 
Ovarian  dropsy. 
Distended  bladder. 
Hydatids  of  liver. 
Pregnancy. 
Chronic  peritonitis. 
Cirrhosis  of  the  liver. 

Simple  Organic  Stricture. 

1.  History  of  injury  or  inflammaUon 

of  oesophagus. 

2.  Pain  inconstant. 


54 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF   DISEASE. 

Cancer  of  CEsophagus. 

3.  Pain  increased  by  taking  food. 

4.  Cervical  glands  enlarged. 

5.  Hemorrhage  common. 

6.  Lungs  affected. 

7.  Bougie  brings  up  cancerous  shreds. 

Cancer  of  CEsophagus, 

1.  History  of  hereditary  cancer. 

2.  Comes  on  gradually. 

3.  Greatest   difficulty    in    swallowing 

solids. 

4.  Cancerous -cachexia. 

5.  Lungs  affected. 

6.  Bougie  meets  with  stricture. 

Acute  Gastritis. 

1.  Temperature  elevated. 

2.  Bowels  usually  constipated. 

3.  Mouth  and  pharynx  normal. 

4.  Symptoms  not  very  severe  at  first. 

5.  Symptoms  do  not  -usually  appear 

within  an  hour  after  eating. 

6.  No  blood  with  vomited  matter. 

7.  No  severe  prostration. 

8.  No  poison  in  vomited  matter. 

Acute  Gastritis. 


DISEASES^  TO    BE   DIFFERENTIATED. 

Simple  Organic  Stricture. 

3.  But  slightly  increased  by  swallow- 

ing. 

4.  Glands  not  enlarged. 

5.  No  hemorrhage. 

6.  Lungs  not  affected. 

7.  Bougie  simply  meets  with  an  ob- 

struction. 

Hysterical  GEsophageal  Stricture. 

1.  History  of  hysteria. 

2.  Begins  suddenly. 

3.  Equally   as    difficult    to     swallow 

liquids  as  solids. 

4.  No  cachexia. 

5.  Lungs  not  affected. 

6.  Bougie  passes  directly  into  stomach. 

Toxic  Gastritis. 

1.  Temperature  often  subnormal. 

2.  Diarrhoea. 

3.  Mouth  and  pharynx  congested. 

4.  Symptoms  severe  from  the  begin- 

ning. 

5.  Symptoms  make  their  appearance 

within  an  hour  after  eating. 

6.  Bloody    mucus    mixed    with    the 

vomited  matter. 

7.  Great  prostration  and  collapse. 

8.  Vomited  matter  contains  poison. 

Acute  Peritonitis. 


See  Acute  Peritonitis  y  page  69. 

Toxic  Gastritis.  Acute  Gastritis. 

(Acute  poisoning.) 

See  Acute   Gastritis,  above. 


DISEASES  OE  DIGESTIVE  TRACT  AND  PERITONEUM.    55 


NAME  OF  DISEASE.  DISEASES  TO  BE  DIFFERENTIATED, 

Toxic  Gastritis.  Acute  Peritonitis. 

See  Acute  Peritonitis,  P^-ge  69. 
Toxic  Gastritis.  Acute  Enteritis. 

See  Acute  Enteritis,  page  58. 
Toxic  Gastritis.  Cholera  Morbus. 

See  Cholera  Morbus,  page  59. 
Toxic  Gastritis.  Cholera. 

See  Cholera,  page  120, 

Chronic  Gastritis.  Dyspepsia. 

Disease  secondary.  i.   Disease  primary. 

Associated  with  chronic  alcoholism,  2.  Dependent  upon  the  habits  of  life. 

renal,  hepatic,  or  thoracic  disease. 

Pain  and  tenderness  in  epigastric  3.   Little  or  no   epigastric    pain    and 

region.  tenderness. 

Tongue  always  coated.  4.  Tongue  pale  and  flabby. 

Constant  thirst.  5.   Moderate  thirst. 

Frequent  vomiting.  6.  Vomiting  infrequent. 

Stimulating  ingesta  aggravate  the  7.   Spices,     etc.,     often     relieve     the 

symptoms.  symptoms. 

Many  deposits  in  urine.  8.   Urine  natural  in  appearance. 

Chronic  Gastritis.  Ulcer  of  Stomach. 

Secondary   disease    of    the   heart,  i.  Disease  primary, 
liver,  or  kidneys. 

Pain  slightly  increased  by  taking  2.   Pain   greatly   increased  by  taking 
food.  food. 

Constant  thirst.  3.  No  thirst. 

Tongue  greatly  coated.  4.   Tongue  red  and  glazed. 

Vomiting  most    frequent  in    early  5.  Vomiting  occurs  after  eating, 
morning. 

Hematemesis  rare.  6.   Hematemesis  common. 

Common    disease     of    adults    and  7.   Common  in  young  adults,  especial- 
elderly  people.  ly  females. 

No  rapid  emaciation.  8.   Emaciation  rapid. 

Deep  pressure  causes  dull  pain.  9.   Deep  pressure  causes  sharp  pain. 


56 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE, 

Chronic  Gastritis. 

1.  Usually  a  secondary  disease. 

2.  Pain  constant  and  moderate. 

3.  Pain  increased  by  taking  food. 

4.  Some  tenderness  on  pressure. 

5.  Vomiting  occasional. 

6.  Hematemesis  rare. 

7.  No  tumor  in  epigastric  region. 

8.  No  enlarged  cervical  glands, 
g.  No  cachexia. 

10.   Temperature  normal. 

Gastric  Dyspepsia. 

Pain  follows  taking  food  imme- 
diately ;  or, 

Pain  occurs  when  the  stomach  is 
empty,  and  relieved  by  taking 
food. 

3.  Vomiting  common. 

4.  Mental   and    constitutional   symp- 

toms not  marked. 

5.  Flatulence  uncommon. 

6.  No  sarcinoe  in  vomited  matter. 

Gastric  Dyspepsia. 

(Vertigo.) 

1.  Plistory  of  dyspepsia. 

2.  Consciousness  never  lost. 

3.  Special   senses   (except   eyes)    not 

afifected. 

4.  Patient  knows  that  the  motion  of 

surrounding  objects  is  unreal. 


I. 


2. 


DISEASES  TO  BE  DIFFERENTIATED. 

Cancer  of  Stomach. 

1.  Disease  hereditary. 

2.  Pain    constant     and     severe,     at 
times. 

3.  Pain  not  increased  by  taking  food. 

4.  No  tenderness  on  pressure. 
.5.  Vomiting  frequent. 

6.  Hematemesis  common. 

7.  Tumor  felt  in  epigastric  region. 

8.  Cervical  glands  enlarged. 

9.  Marked  cachexia. 

10.   Attacks  of  moderate  fever. 

Acid  Fermentation. 

1.  Pain    comes    on    sometimes    after 

eating. 

2.  Pain  never  occurs  with  an  empty 

stomach. 

3.  Vomiting  uncommon. 

4.  Mental    and    constitutional    symp- 

toms well  marked. 

5.  Flatulence  common, 

6.  Sarcinse  present  in  vomited  matter. 

Cerebral  Vertigo. 

1.  History  of  mental  disorder. 

2.  Consciousness  lost  at  times. 

3.  Special  senses  affected. 

4.  Movement  of  surrounding  objects 

seems  real. 


Gastric  Dyspepsia.  Chronic  Gastritis. 

See  Chronic  Gastritis,  page  55, 


DISEASES  OF  DIGESTIVE  TRACT  AND  PERITONEUM.     5/ 

NAME  OF  DISEASE.  DISEASES  TO  BE  DIFFERENTIATED. 

Cancer  of  Stomach.  Chronic  Gastritis. 

See  Chronic  Gastritis^  page  56. 

Cancer  of  Stomach.  Ulcer  of  Stomach. 

1.  History  of  hereditary  cancer.  i.   Histoiy  of  anaemia  or  chlorosis. 

2.  Occurs  in  people  over  forty  years       2.   Occurs  usually  in  young  adults. 

of  age. 

3.  Pain  constant  and  lancinating.  3.   Pain     intermittent  —  worse     after 

eating. 

4.  Deep  pressure  not  painful.  4.   Deep  pressure  very  painful. 

5.  Hematemesis  small  in  amount  and       5.   Hematemesis  bright  red  and  large. 

"coffee    grounds"     in     appear-  in  amount, 

ance. 

6.  Vomiting  appears  late  in  the  dis-       6.  Vomiting  is  one  of  the  first  symp- 

ease.  loms. 

7.  Vomiting    does     not     relieve     the       7.  Vomiting  relieves  the  pain. 

pain. 

8.  Cancerous  cachexia.  ^  8.  Anaemia. 

9.  Presence    of    tumor   in    epigastric       g.   No  tumor  in  region  of  stomach. 

region. 

Cancer  of  Stomach.  Abdominal  Aneurism. 

See  Abdominal  Aneurism,  page  46. 

Cancer  of  Stomach.  Cancer  of  Liver. 

See  Cancer  of  Liver,  page  83. 

Ulcer  of  Stomach.  Chronic  Gastritis. 

See  Chronic  Gastritis,  page  55- 

Ulcer  of  Stomach.  Cancer  of  Stomach. 

See  Cancer  of  Stomach,  above. 

Ulcer  of  Stomach.  Cardialgia. 

1.  History  of  anaemia.  i.   History  of  neuralgia. 

2.  Pain  increased  by  taking  food.  2.    Pain  not  increased  by  eating. 

3.  Pain  increased  by  deep  pressure.  3.    Pain  diminished  by  deep  pressure, 


58 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE 

Ulcer  of  Stomach. 

4.  Electricity  increases  the  pain. 

5.  Hematemesis  common. 

6.  Gastric       disturbance      constantly 

present. 

Hematemesis. 


DISEASES  TO  BE  DIFFERENTIATED. 

Cardialgia. 

4.  Pain  relieved  by  electricity. 

5.  No  hematemesis. 

6.  Gastric     symptoms     only    present 

during  the  attack. 


Hemoptysis. 


See  Hemoptysis,  page  30. 


Acute  Enteritis. 

Onset  comparatively  slow,  i. 

Gastric  symptoms  not  severe.  2. 

Intestinal  symptoms  first  to  make  3. 

their  appearance. 

Temperature  elevated.  4. 

No  vomiting  of  blood.  5. 

Prostration  not  severe.  6. 

Vomited  matter  free  from  poison.  7. 

Mouth  and  pharynx  normal.  8. 

Acute  Enteritis. 

Onset  comparatively  slow.  i. 

Temperature  high.  2. 

Diarrhoea.  3. 

Abdomen  but  slightly  tympanitic.  4. 

Pulse  feeble  and  rapid.  5. 

Vomited  matter  not  characteristic.  6. 

Abdomno-thoracic  breathing.  7. 

No  severe  prostration  or  collapse.  8. 

Acute  Enteritis. 

Onset  comparatively  slow.  i. 

Temperature  high.  2. 


3.  Occasional  attacks  of  diarrhoea  and 
vomiting. 


Acute  Poisoning. 

Onset  sudden. 

Very  severe  gastric  symptoms. 

Gastric    symptoms    first    to   make 

their  appearance. 
Temperature  often  subnormal. 
Vomiting  of  bloody  mucus. 
Great  prostration. 
Vomited  matter  contains  poison. 
Mouth  and  pharynx  often  congested 

and  glazed. 

Acute  Peritonitis. 

Onset  sudden — usually  with  a  chill. 
Temperature  moderate. 
Obstinate  constipation. 
Abdomen  very  tympanitic. 
Pulse  tense  and  wiry. 
Vomited  matter  spinach  green. 
Thoracic  breathing. 
Great  prostration  and  collapse. 

Cholera  Morbus. 

Onset  sudden — usually  at  night. 
Temperature    normal     or    subnor- 
mal. 
Constant  vomiting  and  purging. 


DISEASES  OF  DIGESTIVE  TRACT  AND  PERITONEUM.     59 


NAME  OF  DISEASE. 

Acute  Enteritis. 

4.  No  severe  cramps  in  legs. 

5.  No  rapid  prostration  or  collapse. 

6.  Disease  lasts  a  week  or  more. 

Acute  Enteritis. 

1.  Gastro-intestinal  symptoms  precede 

the  febrile  movement. 

2.  Temperature  not  characteristic. 

3.  No  nose  bleed. 

4.  No  eruption. 

5.  Pain  most  severe  in  umbilical  re- 

gion. 

6.  No  gurgling  in  iliac  fossa. 

7.  Recovery  at  the  end  of  a  week. 

Cholera  Morbus. 

1.  Disease  sporadic. 

2.  Stools  have  a  faecal  or  mouse-like 

odor. 

3.  Stools  contain  bile. 

4.  Evacuations     contain      undigested 

food,  mucus,  fsecal  matter,  etc. 

5.  Pain  with  vomiting  and  purging. 

6.  Urine    not    albuminous     or     sup- 

pressed. 

7.  Temporary  prostration. 

8.  No  comma  bacilli. 


DISEASES  TO  BE  DIFFERENTIATED. 

Cholera  Morbus. 

4.  Severe  cramps  in  legs. 

5.  Sudden  prostration  and  collapse. 

6.  Disease  lasts  a  day  or  two. 

Typhoid  Fever. 

1.  Gastro-intestinal  symptoms  follow 

the  febrile  movement. 

2.  Temperature  characteristic. 

3.  Frequent  nose  bleed. 

4.  Eruption  on  the  seventh  day. 

5.  Pains   most    severe    in    right   iliac 

fossa. 

6.  Gurgling  in  right  iliac  fossa. 

7.  Disease  lasts  four  weeks  or  more. 

Asiatic  Cholera. 

1.  Disease  epidemic. 

2.  Stools  have  no  faecal  odor. 

3.  No  bile  in  stools. 

4.  "Rice  water"   evacuations    often 

from  the  first. 

5.  Painless  vomiting  and  purging. 

6.  Urine   albuminous  and  often  sup- 

pressed. 

7.  Prostration  greater  and  prolonged. 

8.  Presence  of  comma  bacilli. 


Cholera  Morbus.  Acute  Enteritis. 

See  Acute  Enteritis,  page  58. 
Cholera  Morbus.  Acute  Poisoning. 


1.  Begins  with  vomiting  and  purging. 

2.  Pain     not     limited     to     epigastric 

region. 


1.  Vomiting  precedes  the  purging. 

2.  Pain  limited  at  first  to  the  epigas- 

tric refjion. 


6o 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE. 

Cholera  Morbus. 

3.  No  morbid  appearance  of  mouth 

or  pharynx. 

4.  No  blood  in  vomited  matter. 

5.  Pain  colicky  in  character. 

6.  No  poison  in  vomited  matter. 

Cholera  Infantum. 

1.  Temperature  but  slightly  elevated. 

2.  Abdomen  retracted. 

3.  Rapid  emaciation  and  prostration. 

4.  Vomiting  and  purging  excessive. 

5.  Great  thirst. 

6.  Diarrhoea  very  watery. 

7.  Movements  have  a  musty  odor. 

8.  Urine  albuminous  and  often  sup- 

pressed. 

9.  Tendency  toward    coma  and  con- 

vulsions. 

Cholera  Infantum. 

1.  Diarrhoea. 

2.  Pupils  dilated  and  regular. 

3.  Pulse  rapid  and  regular. 

4.  Abdomen  retracted. 

5.  Surface  cold  and  perspiring. 

6.  Tearless  cry. 

Dysentery. 

1.  Begins  acutely. 

2.  Temperature  elevated. 


DISEASES  TO  BE  DIFFERENTIATED. 

Acute  Poisoning. 

3.  Mouth   and    pharynx    often    con- 

gested and   glazed. 

4.  Bloody  mucus  mixed  with  vomited 

matter  and  stools. 

5.  Pain  constant  with  severe  exacer- 

bations. 

6.  Poison    detected    in    the    vomited 

matter. 

Acute  Enteritis  of  Children. 

1.  Temperature  high. 

2.  Abdomen  tympanitic 

3.  Less  rapid  emaciation  and  prostra- 

tion. 

4.  Vomiting    and    purging    occur    at 

intervals. 

5.  Thirst  not  excessive. 

6.  Diarrhoea — faeces  containing  undi- 

gested food. 

7.  Movements  have  a  faecal  odor. 

8.  Urine  not    suppressed    or  albumi- 

nous. 

9.  Coma  and  convulsions  rare. 

Acute  Hydrocephalus. 

1.  Constipation  usually. 

2.  Pupils"  contracted  and  irregular. 

3.  Pulse  slow  and  irregular. 

4.  Abdomen  tympanitic. 

5.  Surface  dry  and  hot. 

6.  Hydrocephalic  cry.' 

Diarrhoea  with  Hemorrhoids. 

1.  History  of  hemorroids. 

2.  Temperature  norm.al. 


DISEASES  OF  DIGESTIVE  TRACT  AND  PERITONEUM.     6 1 


NAME   OF   DISEASE. 

Dysentery. 

3.  Constitutional      symptoms      well 

marked. 

4.  Stools  scanty  in  amount. 

5.  Stools  contain  mucus  and  blood. 

6.  On   examination    find   absence    of 

hemorrhoids. 

Dysentery. 

1.  Begins  acutely  with  chill,  etc. 

2.  Constitutional      symptoms      well 

marked. 

3.  Severe  pain  in  abdomen. 

4.  Temperature  elevated. 

5.  Diarrhoea. 

6.  Abdomen  tympanitic  and  tender. 

Chronic  Dysentery. 

1.  History  of  an  acute  attack. 

2.  Bearing  down  pains  in  rectum. 

3.  Diarrhoea  common. 

4.  Faeces  pasty  and  mixed  with  mu- 

cus and  blood. 

5.  Anaemia  and  debility. 

6.  Rectal  examination  shows  disease 

of  m.ucous  membrane. 

Perityphlitis. 

1.  Presence  of  tumor  before  intestinal 

syraptoms  are  developed. 

2.  Pain  deep-seated. 

3.  Pain    increased    upon    motion    of 

thigh. 

4.  Presence  of  fluctuation. 


DISEASES    TO    BE   DIFFERENTIATED. 

Diarrhoea  with  Hemorrhoids. 

3.  No  severe  constitutional  symptoms. 

4.  Stools  copious. 

5.  Stools   contain    blood    and    fspcal 

matter. 

6.  Examination  shows  presence  of  en- 
larged veins. 

Acute  Proctitis. 

1.  Begins    with    uneasy    feeling    in 

rectum. 

2.  No  constitutional  symptoms. 

3.  Pain  limited  to  rectum. 

4.  Temperature  about  normal. 

5.  Constipation. 

6.  Abdomen  not  tjinpanitic  or  tender. 

Cancer  of  Rectum. 

1.  History  of  hereditary  cancer. 

2.  Pain  lancinating. 

3.  Constipation. 

4.  Faeces     ribbon-like    and    covered 

with  mucus  and  blood. 

5.  Cancerous  cachexia. 

6.  Rectal  examination  shows  presence 

of  tumor. 

Typhlitis. 

1.  Begins  with  colicky  pains  and  ir- 

regular action  of  bowels. 

2.  Pain  superficial. 

3.  Pain    not    increased    by    moving 

thigh. 

4.  No  fluctuation. 


62 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF    DISEASE. 

Perityphlitis. 

5.  Tumor  irregular  and  deep-seated. 

6.  Dulness  on  percussion  over  tumor 

has  a  tympanitic  character. 

7.  Fever,  chills,  and  sweats. 


DISEASES  TO   BE   DIFFERENTIATED. 

Typhlitis. 

5.  Tumor  superficial  and  regular. 

6.  No    tympanitic    character   to   the 

dulness. 

7.  Absence  of  chills  and  sweating. 


Perityphlitis. 

Cancer  of  Caecum. 

I. 

2. 

3- 
4. 

5. 
6. 

Usually  the  result  of  typhlitis. 
Tumor  develops  rapidly. 
Pain  throbbing  in  character. 
Pain    increased  by   movement  of 

thigh. 
Tumor  fluctuating. 
Fever,  chills,  and  sweating. 

I. 

2. 

3- 
4. 

5. 
6. 

History  of  hereditary  cancer. 

Tumor  develops  slowly. 

Pain  lancinating. 

Pain  not  increased  by  movement 

of  thigh. 
Tumor  solid. 
'No  chills  or  sweating. 

Perityphlitis. 

Distension  of  Caecum. 

I. 
2. 
3. 
4. 

5. 

History  of  typhHtis, 

Fever,  chills,  and  sweating. 

Tumor  fluctuates. 

Pain    increased    by    moving    the 
right  thigh. 

Symptoms  not  relieved  by  an  ene- 
ma or  cathartic. 

I. 
2. 

3. 
4. 

5. 

History  of  constipation. 

No  fever,  chills,  or  sweating. 

No  fluctuation. 

No  pain  produced  by  movements  of 
thigh. 

Symptoms  relieved  by  an  enema  or 

cathartic. 

Perityphlitis. 

Psoas  Abscess. 

2. 

3. 
4. 

History  of  typhlitis. 

Intestinal  symptoms  well  marked. 

No  pain  in  spine. 

Fluctuating  tumor  appears  gradu- 

I. 
2. 

3. 
4- 

History  of  disease  of  spine. 
No  well-marked  intestinal   symp- 
toms. 
Aching  pain  in  back. 
Tumor  often  appears  suddenly. 

ally. 

5.  Constitutional  symptoms  are  well 

marked. 

6,  The  pus  has  a  faecal  odor. 


5.  No    severe    constitutional    symp- 

toms. 

6.  No  faecal  odor  to  the  pus. 


DISEASES  OF  DIGESTIVE  TRACT  AND  PERITONEUM.    63 


NAME  OF  DISEASE. 

Perityphlitis. 

1.  Tumor  develops  slowly. 

2.  Simple  constipation. 

3.  No  blood  or  mucus  with  stools. 

4.  Irregular  chills  and  sweating. 

5.  No  stercoraceous  vomiting. 

6.  Tumor  irregular  in  shape. 

7.  No  severe  collapse  or  prostration. 

Intestinal  Obstruction. 

1.  Obstinate  constipation. 

2.  Pain  persistent. 

3.  Pain  not  relieved  by  pressure. 

4.  Stercoraceous  vomiting. 

5.  Symptoms  of  profound  collapse. 

Intestinal  Obstruction. 

1.  Temperature  normal    or    subnor- 

mal. 

2.  Pulse  feeble  and  rapid. 

3.  Stercoraceous  vomiting. 

4.  Pain  localized. 

5.  Some  tenderness  upon  pressure. 

6.  Abdomino-thoracic  breathing. 

Intestinal  Obstruction. 

1.  Faecal  vomiting. 

2.  Pain  localized  and  constant. 

3.  Obstinate  constipation. 

3.   Urine  lessened  in  amount. 

5.  No  jaundice. 

6.  Pressure  increases  the  pain. 


DISEASES  TO   BE  DIFFERENTIATED. 

Intussusception. 

1.  Tumor  develops  suddenly. 

2.  Complete  intestinal  obstruction. 

3.  Small,    bloody,   and   mucous   pas- 

sages. 

4.  No  chills  or  sweating. 

5.  Stercoraceous  vomiting. 

6.  Tumor  sausage-shaped. 

7.  Sudden  collapse  and  prostration. 

Intestinal  Colic. 

1.  Bowels  irregular. 

2.  Pain  intermittent. 

3.  Pain  relieved  by  pressure. 

4.  No  vomiting. 

5.  No  collapse. 

Acute  Peritonitis. 

1.  Temperature  elevated. 

2.  Pulse  tense  and  wiry. 

3.  Spinach-green  vomiting. 

4.  Pain  general  over  abdomen. 

5.  Great  abdominal  tenderness. 

6.  Thoracic  breathing. 

Hepatic  Colic. 

1.  Vomiting  not  stercoraceous. 

2.  Pain    paroxysmal    and    radiating 

from  gall  bladder  to  back. 

3.  Stools  clay-colored. 

4.  Urine  contains  bile  pigment. 

5.  Jaundice  common. 

6.  Pressure  relieves  the  pain. 


64 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Intestinal  Obstruction. 

1.  Fsecal  vomiting. 

2.  Pain  localized  and  constant. 

3.  Urine  diminished  in  amount. 

4.  Complete  constipation. 

5.  No  pain  in  testicles. 

6.  Pressure  increases  the  pain. 

Intestinal  Obstruction. 

1.  Onset  sudden.' 

2.  Faecal  vomiting. 

3.  Tympanitic    distension    of    abdo- 

men. 

4.  Cathartics  increase  the  severity  of 

the  symptoms. 

5.  No   scybala  felt   through  the  ab- 

dominal wall. 

6.  Great  prostration  and  collapse. 

Tubercular  Enteritis. 

(Ulcer  of  intestine.) 

1.  Abdomen  distended. 

2.  Diarrhoea. 

3.  Pulse  accelerated. 

4.  Pupils  normal. 

5.  Vomiting  rare. 

6.  Inordinate  hunger. 

Tubercular  Enteritis. 

(Ulcer  of  Intestine.) 

1.  Abdomen  distended  and  flaccid. 

2.  Pain  moderate   and  not  increased 

upon  pressure. 

3.  Rapid  emaciation. 

4.  Cervical  glands  enlarged. 


DISEASES  TO   BE  DIFFERENTIATED. 

Renal  Colic. 

1.  No  stercoraceous  vomiting. 

2.  Pain     paroxysmal     and     extends 

along  ureters  to  penis  of  testicle. 

3.  Urine  bloody. 

4.  Bowels  normal. 

5.  Testicles  painful  and  retracted. 

6.  Pressure  relieves  the  pain. 

Chronic  Constipation. 

1.  History  of  constipation. 

2.  Absence  of  vomiting. 

3.  No  tympanites. 

4.  Cathartics  relieve  the  symptoms. 

5.  Scybala  felt   through   the   abdom- 

inal wall. 

6.  No  severe  constitutional  symptoms. 

Tubercular  Meningitis. 

1.  Abdomen  retracted. 

2.  Constipation. 

3.  Pulse  retarded. 

4.  Pupils  contracted  and  irregular. 

5.  Vomiting  frequent  and  projectile. 

6.  Loss  of  appetite. 

Tubercular  Peritonitis. 

1.  Abdomen  distended  and  rigid. 

2.  Pain  severe  and  increased  by  pres- 

sure. 

3.  Emaciation  less  rapid. 

4.  Glands  not  enlarged, 


DISEASES  OF  DIGESTIVE  TRACT  AND  PERITONEUM.    65 


NAME    OF    DISEASE. 

Tubercular  Enteritis. 

5,  No  ascites. 

5.  Tympanitic  percussion  note. 
7.  No  redness  around  umbilicus. 

Cancer  of  Intestine. 

History  of  hereditary  cancer. 
Cancerous  cachexia. 
Pain  lancinating. 
Tumor  irregular  in  shape. 
Tumor  in  front  of  intestines, 

6.  Pain  not  much  increased  by  ma- 

nipulation. 


DISEASES   TO   BE   DIFFERENTIATED. 

Tubercular  Peritonitis. 

5.  Ascites  common. 

6.  Dulness  on  percussion. 

7.  Redness  and    oedema  around  um- 

bilicus. 

Floating  Kidney. 

1.  No  hereditary  tendencies. 

2.  No  cachexia. 

3.  Pain  dull. 

4.  Tumor  kidney  shape. 

5.  Tumor  behind  intestine. 

6.  Sickening      pain      produced 

squeezing  tumor. 


by 


Cancer  of  Intestine.  Perityphlitis. 

See  Perityphlitis,  page  62, 


Cancer  of  Intestine. 

1.  History  of  hereditary  cancer. 

2.  Cancerous  cachexia. 

3.  Bloody  mucus  with  stools. 

4.  Faeces  ribbon  like. 

5.  Pain  lancinating  in  character. 

6.  By  examination   find   a   tumorous 

mass  in  rectum. 


^   Hemorrhoids. 

1.  History  of  sedentary  habits,    dis- 

ease of  the  liver,  etc. 

2.  No  cachexia. 

3.  Occasional  hemorrhage  from  bowel. 

4.  Faeces  normal  in  shape. 

5.  Dragging  pain  in  rectum. 

6.  On     examination     find    enlarged 

veins  in  rectum. 


Cancer  of  Intestine.  Abdominal  Aneurism. 

See  Ahdo7ninal  Aneurism,  page  47. 


Proctitis. 

1.  Begins  with  tenesmus. 

2.  Stools   contain    gelatinous    mucus 

and  blood. 


Periproctitis. 

Begins  with  pain  and  tenderness 

in  anal  region. 
Stools   do   not   contain    blood    or 

mucus. 


66 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF    DISEASE. 

Proctitis. 

3.  No  chills,  fever,  or  sweating. 

4.  No  external  signs  of  inflammation. 

5.  No  fluctuating  tumor. 

6.  Examination  shows  diseased   con- 

dition of  rectal  mucus  membrane. 

Proctitis. 

1.  Tenesmus  severe. 

2.  Stools  contain  mucus  and  blood. 

3.  No  external  appearance  of  disease. 


DISEASES   TO    BE   DIFFERENTIATED. 

Periproctitis. 

3.  Chills,  fever,  and  sweating. 

4.  External  signs  of  inflammation. 

5.  Presence  of  fluctuating  tumor. 

6.  On     examination     an    abscess    is 

found  in  neighborhood  of  rectum. 

Hemorrhoids. 

Pain  greater  than  the  tenesmus. 


Examination  shows  diseased  con- 
dition of  the  rectal  mucous  mem- 
brane. 

Proctitis. 


Stools  contain  pure  blood. 

Hemorrhoids  often  appear  exter- 
nally. 

Examination  shows  enlarged  veins 
in  rectum. 


Dysentery. 

See  Dysentery,  page  61. 

Proctitis.  Cancer  of  Intestine. 

See  Cancer  of  Intestine,  page  65. 

Hemorrhoids.  Proctitis. 

See  Proctitis^  above. 

Hemorrhoids.  Dysentery. 

See  Dysentery,  page  60. 
Hemorrhoids.  Cancer  of  Intestine. 

See  Cancer  of  Intestine,  page  65. 


Hemorrhoids. 

1.  Tenesmus. 

2.  Bearing  down  pain  in  rectum. 

3.  Constipation. 

4.  Blood  bright  red  and  covers  faeces. 


Intestinal  Hemorrhage. 

1.  No  tenesmus. 

2.  Abdominal  pain. 

3.  Usually  diarrhoea. 

4.  Blood  tarry  and  mixed  with  faeces. 


DISEA  SES  OF  DIGEST!  VE  TRA  CT  A  ND  PERI  TONE  UM.     6/ 


NAME   OF   DISEASE. 

Hemorrhoids. 

5.  No  constitutional  symptoms. 

6.  Rectal  examination  shows  presence 

of  enlarged  veins. 

Intestinal  Colic. 

1.  No  fever. 

2.  Pulse  slow  and  full. 

3.  Great  restlessness. 

4.  Pressure  relieves  the  pain. 

5.  Pain  paroxysmal. 

6.  No  vomiting. 

Intestinal  Colic. 

1.  Pain  paroxysmal. 

2.  Temperature  normal. 

3.  Pulse  slow  and  full. 

4.  Pressure  relieves  the  pain. 

5.  No  marked  tympanites. 

6.  No  real  prostration  or  collapse. 

7.  No  hemorrhage  from  bowels. 

Intestinal  Colic. 


DISEASES   TO   BE   DIFFERENTIATED. 

Intestinal  Hemorrhage. 

5.  Well-marked  constitutional  symp- 

toms. 

6.  Rectal  examination  negative. 

Acute  Peritonitis. 

1.  High  temperature. 

2.  Pulse  rapid  and  wiry. 

3.  Patient  perfectly  still. 

4.  Pressure  increases  the  pain. 

5.  Pain  constant. 

6.  Spinach-green  vomiting. 

Perforation  of  Intestine. 

1.  Pain    constant     with    paroxysmal 

aggravations. 

2.  Temperature  often  subnormal. 

3.  Pulse  rapid  and  feeble. 

4.  Pressure  increases  the  pain. 

5.  Tympanites. 

6.  Great  prostration  and  collapse. 

7.  Hemorrhage  from  bowel  common. 

Intestinal  Obstruction. 


See  Intestinal  Obstruction,  page  63. 


Intestinal  Colic. 

No  vomiting. 
No  jaundice. 
Pain  most  severe  in  the  umbilical 


region. 

4.  Bowels  irregular. 

5.  Pain  colicky  in  character. 

6.  No  gall  stones  in  faeces. 

7.  Urine  normal. 


Hepatic  Colic. 

1.  Vomiting. 

2.  Jaundice. 

3.  Pain  most  severe  in  epigastric  re- 

gion, shooting  toward  back. 

4.  Stools  clay-colored. 

5.  Pain  tearing  in  character. 

6.  Gall  stones  in  fseces. 

7.  Urine  contains  bile  pigment. 


68 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF    DISEASE. 

Intestinal  Colic. 

1.  Urine  normal. 

2.  No  pain  in  testicles. 

3.  Pain    most     severe    in     umbilical 

region. 

4.  Pain  colicky  in  character. 

5.  No  vomiting. 

6.  No  numbness  of  thigh. 

Intestinal  Colic. 

1.  Pain  paroxysmal. 

2.  Pain  relieved  by  pressure. 

3.  Pain   of  greatest  intensity  in  um- 

bilical region. 

4.  History   of   indigestion,    exposure 

to  cold,  etc. 

5.  No  spots  of  extreme  tenderness. 

6.  Pain  deep-seated. 

Intestinal  Colic. 

1.  Occurs  at  any  time. 

2.  Pain  intermittent. 

3.  Pain  in  umbilical  region  most  se- 

vere. 

4.  No  vomiting. 

5.  No  bladder  symptoms. 

6.  Pain  relieved  by  pressure. 


DISEASES   TO    BE   DIFFERENTIATED. 

Renal  Colic. 

1.  Urine  passed  frequently  and  con- 

tains blood. 

2.  Testicle  retracted  and  painful. 

3.  Pain    shoots     along    ureters    into 

testicle  to  penis. 

4.  Pain  tearing  and  shooting. 

5.  Frequent  vomiting, 

6.  Marked  numbness  of  thigh. 

Abdominal  Rheumatism. 

1.  Pain  constant. 

2.  Pain  increased  by  pressure. 

3.  Pain  of  greatest  intensity  over  the 

origin  and  insertion  of  muscles. 

4.  History  of  rheumatism. 

5.  Spots  of  Hyperaesthesia. 

6.  Pain  superficial. 

Uterine  Colic. 

1.  At  menstrual  period. 

2.  Pain  remittent. 

3.  Pain  most  severe  in  the  hypogas- 

tric or  pelvic  region. 

4.  Vomiting  common. 

5.  Irritability  of  the  bladder. 

6.  Pain  increased  by  pressure. 


Acute  Peritonitis.  Acute  Enteritis. 

See  Acute  Enteritis,  page  58. 
Acute  Peritonitis.  Intestinal  Colic. 

See  Intestinal  Colic,  page  67. 

Acute  Peritonitis.  Intestinal  Obstruction. 

See  Intestinal  Obstruction,  page  63. 


DISEASES  OF  DIGESTIVE  TRACT  AND  PERITONEUM.     69 


NAME   OF   DISEASE. 

Acute  Peritonitis. 

1.  Temperature  elevated. 

2.  Harder  the  pressure  more    severe 

the  pain. 

3.  Pulse  tense  and  wiry. 

4.  Great  prostration. 

5.  Peritonitic  countenance  and  posi- 

tion. 

6.  Spinach-green  vomiting. 

Acute  Peritonitis. 

1.  Pain  increased  by  pressure. 

2.  Patient  very  quiet. 

3.  Temperature  elevated. 

4.  No   change   in  color  of  faeces    or 

urine. 

5.  Great  tympanites. 

6.  Severe  collapse  and  prostration. 

Acute  Peritonitis. 

1.  No  vomiting  at  first. 

2.  Vomiting  inconstant  and  spinach- 

green  in  color. 

3.  Pain  diffuse. 

4.  Great  tympanites. 

5.  Peritonitic  countenance  and  posi- 

tion. 

6.  Constipation. 

Acute  Peritonitis. 

1.  Temperature  elevated. 

2.  Begins  with  chill  and  pain  in  ab- 

domen. 

3.  Spinach-green  vomiting. 


DISEASES   TO    BE   DIFFERENTIATED. 

Hysteria. 

1.  Temperature  normal. 

2.  A  light  touch  causes  as  much  pain 

as  deep  pressure. 

3.  Pulse  normal. 

4.  Prostration  only  apparent. 

5.  Hysterical  countenance   and  rest- 

lessness. 

6.  Globus  hysterica. 


Renal  or  Hepatic  Colic. 

1.  Pain  diminished  by  pressure. 

2.  Great  restlessness. 

3.  Temperature  normal. 

4.  Fseces  or  urine   has  an  abnormal 

color. 
Tympanites  absent  or  slight. 
Prostration  but  temporary. 


5. 


Acute  Gastritis. 

1.  Begins  with  vomiting. 

2.  Vomiting  constant  and  bilious. 

3.  Pain  limited  to  gastric  region. 

4.  Tympanites  moderate  or  absent. 

5.  Countenance     pale,    position    not 

characteristic. 

6.  Bowels  normal  or  irregular. 

Acute  Poisoning. 

1.  Temperature    normal    or    subnor- 

mal. 

2.  Begins  with  vomiting  and  pain  in 

the  stomach. 

3.  Vomited    matter    contains    blood 

and  mucus. 


70 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE. 

Acute  Peritonitis. 

4.  Obstinate  constipation. 

5.  No  cramps  in  legs. 

6.  Mouth  and  pharynx  normal. 

7.  Abdomen  tympanitic. 

8.  No  poison  in  vomited  matter. 


DISEASES   TO    BE   DIFFERENTIATED. 

Acute  Poisoning. 

4.  Diarrhoea. 

5.  Severe  cramps  in  legs. 

6.  Mouth     and     pharynx     red     and 

glazed. 

7.  Abdomen  retracted. 

8.  Vomited  matter  contains  poison. 


Cancerous  Peritonitis. 

I.   History  of  hereditary  cancer. 


Chronic  Peritonitis. 

1.  History  of  an  acute  attack. 

2.  Temperature     irregular  —  99°    to       2.   Temperature  usually  normal. 

104°. 

3.  Ascitic  fluid  clear. 

4.  Anaemia. 

5.  Occasional  chills. 

6.  No  tumefaction  of  the  omentum. 

7.  No  cancer  cells  in  ascitic  fluid. 


3.  Ascitic  fluid  bloody. 

4.  Cancerous  cachexia. 

5.  No  chills. 

6.  Tumefaction  of  the  omentum. 

7.  Ascitic  fluid  contains  cancer  cells. 


Chronic  Peritonitis. 

1.  History  of  an  acute  attack. 

2.  Constipation  alternating  with  diar- 

rhoea. 

3.  No  redness  around  umbilicus. 

4.  Ascitic  fluid  clear. 

5.  No  tubercle  bacilli  in  fluid. 

6.  No   sign  of   tubercular  disease  in 

other  organs,  as  the  lungs. 

7.  Frequent  chills. 

8.  Moderate  ascites. 

9.  Typhoid  symptoms  appear  late. 

Chronic  Peritonitis. 

1.  History  of  an  acute  attack. 

2.  No  general  oedema. 

3.  Abdomen  painful. 


Tubercular  Peritonitis. 

1.  History  of  tuberculosis. 

2.  Constant  diarrhoea. 

3.  Redness  and  oedema  around  um- 

bilicus. 

4.  Ascitic  fluid  hemorrhagic. 

5.  Fluid  contains  tubercle  bacilli. 

6.  Lungs  and  other  organs  frequently 

tuberculous. 

7.  Frequent  profuse  sweating. 

8.  Ascites  well-marked. 

9.  Typhoid  symptoms  appear  early. 

Ascites. 

1.  History  of  kidney,  liver,  and  heart 

disease. 

2.  General  oedema. 

3.  No  pain  in  abdomen. 


DISEA  SES  OF  DIGESTIVE  TRA  CT  A ND  PERI  TONE  UM.      7 1 


NAME   OF    DISEASE. 

Chronic  Peritonitis. 

4    Tenderness  upon  pressure, 

5.  Temperature  irregular. 

6.  Abdominal  veins  not  dilated. 

Tubercular  Peritonitis. 

1.  History  of  tuberculosis. 

2.  Tubercular  disease  of  other  organs. 


3.  Ascites  well-marked. 

4.  Profuse  sweats. 

5.  Temperature    elevated,    especially 

at  night. 

6.  Redness  and  oedema  around  um- 

bilicus. 
Abdomen  has  a  doughy  feeling. 

Tubercular  Peritonitis. 


7. 


DISEASES   TO    LE   DIFFERENTIATED. 

Ascites. 

4.  No  tenderness  on  pressure. 

5.  Temperature  normal. 

6.  Dilatation  of  abdominal  veins. 

Cancerous  Peritonitis. 

1.  History  of  hereditary  cancer. 

2.  Surrounding  organs  frequently  can- 

cerous. 

3.  Ascites  usually  not  well-marked. 

4.  No  profuse  sweats. 

5.  Temperature    about   normal — can- 

cerous cachexia. 

6.  No  redness  or  oedema  about  um- 

bilicus. 

7.  Abdomen  feels  tumorous. 

Chronic  Peritonitis. 


See  Chronic  Poiionitis,  page  70. 

Tubercular  Peritonitis.  Tubercular  Enteritis. 

See    Tubercular  Enteritis,  page  64. 

Ascites  (Abdominal  Dropsy).  Chronic  Peritonitis. 

See  Chronic  Peritonitis,  page  70. 


Ascites. 

1.  Uniform  enlargement. 

2.  Begins    in    dependent    portion    of 

abdomen. 

3.  Line  of  dulness  changes  with  po- 

sition of  patient. 

4.  Fluctuation  well-marked. 

5.  History  of  liver,   kidney,  or  heart 

disease. 

6.  Fluid  serous  in  character. 


Ovarian  Dropsy, 
r.  Irregular  abdominal  enlargement. 

2.  Begins  in  one  iliac  fossa. 

3.  Line  of  dulness  stationary. 


Fluctuation  indistinct. 

No  history  of  previous  disease. 


No    well-defined   outline   of 
ness. 


dul- 


6.  Fluid     albuminous    and    contains 

characteristic  cells. 

7.  Distinct  outline  of  cyst  wall,  which 

limits  the  area  of  dulness. 


72     DISEASES  OF  DIGESTIVE   TRACT  AND  PERITONEUM. 


NAME   OF    DISEASE. 

Ascites. 

No  bladder  symptoms. 

Line  of  dulness  changes  with  po- 
sition of  patient. 

No  pain  on  pressure. 

No  uniform  outline  of  dulness. 

Symptoms  not  relieved  by  passing 
catheter. 

Ascites. 

Line  of  dulness  changes  with  po- 
sition of  patient. 

Fmctuation  well-marked. 

No  mammary  changes. 

No  well-defined  outline  to  dul- 
ness. 

No  fcetal  heart. 

No  ballotement. 

Ascites. 

Flatness  begins  below. 
Line   of  dulness  changes  with  po- 
sition of  patient. 
No  fremitus  on  percussion. 
Tympanites  above  the  flat  area. 
No  booklets  in  fluid. 


DISEASES   TO    BE   DIFFERENTIATED. 

Distended  Bladder. 

1.  Retention  or  incontinence  of  urine. 

2.  Line  of  dulness  uniform^ 

3    Pain  produced  by  pressure, 

4.  Dulness  has  a  rounded  outline. 

5.  Distention     relieved     by     passing 

catheter. 

^  Pregnancy. 

1.  Line  of  dulness  constant, 

2.  Fluctuation  indistinct. 

3.  Well-marked  mammary  signs. 
4. 


Uterus  has  a  well-defined  outline. 


Foetal  heart. 
Ballotement. 


Hydatids  of  Liver. 


1.  Flatness  begins  above. 

2.  Line  of  dulness  constant. 

3.  Hydatid  fremitus  on  percussion. 

4.  Tympanites  below  the  flat  area. 

5.  Hooklets  found  in  the  fluid. 


Ascites.  Cirrhosis  of  the  Liver, 

See  Cirrhosis  of  the  Liver,  page  78, 


DIFFERENTIAL   DIAGNOSIS   OF   THE    DISEASES    OF 

THE   LIVER. 


DIFFERENTIAL    DIAGNOSIS    OF    THE    DISEASES   OF 

THE    LIVER. 


NAME   OF  DISEASE. 


Acute  congestion  of  the  liver 


Cirrhosis  of  the  liver 


Abscess  of  the  liver    . 


Acute  yellow  atrophy- 


Fatty  liver 


DISEASES   TO    BE   DIFFERENTIATED. 


Abscess  of  the  liver. 


<   Fatty  liver. 

(  Catarrh  of  the  bile  ducts. 

Fatty  liver. 

Cancer  of  liver. 

Ascites  due  to  other  causes. 

Hydatids  of  the  liver. 

Cancer  of  the  liver. 

Acute  congestion  of  the  liver. 

Abscess  in  abdominal  walls. 

Enlarged  gall-bladder. 

Perihepatitis. 

Empyema. 

Pylephlebitis. 

'  Yellow  fever. 
Pyaemia. 

Bilious  remittent  fever. 
Simple  jaundice. 
Remittent  fever. 

Waxy  liver. 

Acute  congestion  of  liver. 

Cancer  of  liver. 


75 


76 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 


Cancer  of  Liver 


Hydatids  of  liver 


Perihepatitis 


DISEASES   TO    BE   DIFFERENTIATED, 

Cirrhosis  of  liver. 
Fatty  liver. 
Abscess  of  liver. 
Hydatids  of  liver. 
Cancer  of  stomach. 
Cancer  of  kidney. 

Ascites. 

Cancer  of  liver. 
Abscess  of  liver. 
Enlarged  gall-bladder. 
Abdominal  aneurism. 
Cyst  of  kidney. 

Abscess  of  liver. 
Intercostal  neuralgia. 
Acute  pleurisy. 


Hepatic  colic 


Hepatogenous  jaundice 


Acute  Congestion  of  Liver. 

1.  Uniform  enlargement  of  liver. 

2.  Rapid  enlargement  of  liver. 

3.  Pain  diffuse  over  liver. 

4.  Pain  not  severe. 

5.  Pulse  slow  or  normal. 

6.  No  chill,  fever,  or  sweating. 

7.  But  slight  tenderness  on  pressure. 


Renal  colic. 
Intestinal  colic. 
Acute  peritonitis. 
Cardialgia. 

Hematogenous  jaundice. 
Acute  yellow  atrophy. 
Acute  congestion  of  liver. 


Abscess  of  Liver. 


Irregular  enlargement  of  liver. 
Enlargement  takes  place  slowly. 
Pain  localized. 
Pain  quite  severe. 
Pulse  rapid. 

6.  Chills,  fever,  and  profuse  sweats. 

7.  Well-marked  tenderness  on  pres- 

sure, 


DISEASES  OF  THE  LIVER. 


77 


NAME   OF   DISEASE. 

Acute  Congestion  of  Liver. 

1.  History  of  alcoholism,  gout,  syph- 

ilis, etc. 

2.  Pain  over  liver. 

3.  Dyspeptic  symptoms. 

4.  Skin  dingy  and  rough. 

5.  On  palpation  liver  feels  hard  and 

resistant. 

6.  Some  tenderness  on  pressure. 

7.  Hemorrhoids  common. 

Acute  Congestion  of  Liver. 

1.  Jaundice  slight. 

2.  Gastro-duodenitis      succeeds      the 

hepatic  symptoms. 

3.  Hemorrhoids  common. 

4.  Liver  considerably  enlarged. 

5.  Tenderness  on  pressure. 

6.  Marked  dizziness  at  times. 

Cirrhosis  of  Liver. 

1.  History  of  alcoholism, syphilis,  etc. 

2.  Skin  dingy  and  rough. 

3.  Liver  hard  and  resistant  on  palpa- 

tion. 

4.  Some  tenderness  on  pressure. 

5.  Emaciation, 

6.  Spleen  enlarged. 

7.  Ascites. 

8.  Liver  usually  diminished  in  size. 

Cirrhosis  of  Liver. 

1.  Liver  usually  small. 

2.  If    nodular,    the  nodules    are    not 

well  marked. 


DISEASES   TO    BE   DIFFERENTIAIED. 

Fatty  Liver. 

1.  History  of  high  living  or  phthisis. 

2.  No  pain  over  liver. 

3.  Dyspeptic  symptoms  uncommon. 

4.  Skin  yellow  and  greasy. 

5.  Liver  feels  soft  and  doughy. 

6.  No  tenderness  on  pressure. 

7.  Hemorrhoids  uncommon. 

Catarrh  of  Bile  Ducts. 

1.  Jaundice  well-marked. 

2.  Gastro-duodenitis      precedes      the 

hepatic  symptoms. 

3.  Hemorrhoids  unfrequent. 

4.  Liver  slightly  enlarged. 

5.  No  tenderness  upon  pressure. 

6.  Patient  stupid  and  drowsy. 

Fatty  Liver. 

I.   History    of   high   living,    phthisis. 


etc. 


Skin  yellow  and  greasy. 
Liver  soft  and  doughy. 


4.  No  tenderness  on  pressure. 

5.  Obesity. 

6.  Spleen  normal. 

7.  No  ascites. 

8.  Liver  always  large. 

Cancer  of  Liver. 

1.  Liver  always  enlarged. 

2.  Nodules  well  marked. 


78 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Cirrhosis  of  Liver. 

3.  Spleen  enlarged. 

4.  Ascites. 

5.  Slight  pain  over  liver. 

6.  But  slight  tenderness  on  pressure. 

7.  Skin  has  a  dingy  hue. 

8.  Gastric  and  intestinal  hemorrhages 

common, 
g.   Enlarged  abdominal  veins. 

Cirrhosis  of  Liver. 

1.  Liver  small. 

2.  Gastric  and  intestinal  hemorrhages 

common. 

3.  Spleen  enlarged. 

4.  Dropsy  begins  as  ascites. 

5.  Enlarged  abdominal  veins. 

6.  Hemorrhoids  common. 

7.  Absence  of  disease  in  other  organs. 

Abscess  of  Liver. 

1.  Occurs    most   frequently   in   those 

who  have  lived  in  hot  climates. 

2.  Rapid  and  acute  disease. 

3.  Severe  pain. 

4.  Chills,  fever,  and  sweating. 

5.  Well-marked  gastric  symptoms. 

6.  No  peculiar  fremitus  produced  on 

percussion. 

7.  Exploring  needle  withdraws  pus. 

Abscess  of  Liver. 

1.  Primary  disease. 

2.  Rapid  enlargement  of  liver. 


DISEASES    TO    BE    DIFFERENTIATED. 

Cancer  of  Liver. 

3.  Spleen  not  enlarged. 

4.  No  ascites. 

5.  Severe  pain  over  liver. 

6.  Marked  tenderness  on  pressure. 

7.  Cancerous  cachexia.  • 

8.  Hemorrhages  rare  unless  the  dis- 

ease is  complicated. 

9.  Adominal  veins  not  enlarged. 

Ascites  due  to  other  Causes. 

1.  Liver  normal  size. 

2.  Hemorrhages  rare. 

3.  Spleen  normal  size. 

4.  Dropsy   begins    in  extremities   or 

face. 

5.  Abdominal  veins  not  enlarged. 

6.  Hemorrhoids  unfrequent. 

7.  Disease    of    heart,    kidneys,    peri- 

toneum, etc. 

Hydatids  of  Liver. 

I.   Occurs  most  frequently  in  cold  cli- 
mates. 
!2.   Slow  and  chronic  disease. 

3.  Little  or  no  pain. 

4.  No  chills,  fever,  or  sweating. 

5.  No  gastric  disturbance. 

6.  Hydatid  fremitus  or  thrill  produced 

by  percussion. 

7.  Fluid  contains  hooklets. 

Cancer  of  Liver. 

1.  Disease  hereditary  or  secondary. 

2.  Liver  enlarges  slowly. 


DISEASES  OF  THE  LIVER. 


79 


NAME   OF   DISEASE. 

Abscess  of  Liver. 

3.  Fever,  chills,  and  sweating. 

4.  No  nodular  feel  on  palpation. 

5.  Patient  hectic  in  appearance. 

6.  Ascites  uncommon. 

7.  Exploring  needle  withdraws  pus. 

Abscess  of  Liver. 


4. 


DISEASES    TO    BE    DIFFERENTIATED. 

Cancer  of  Liver. 

3.  No  chills  or  sweating. 

4.  Liver  distinctly  nodular. 

5.  Cancerous  cachexia 

6.  Ascites  not  infrequent. 

7.  Exploring  needle  withdraws  blood. 

Acute  Congestion  of  Liver. 


See  Acute  Congestion  of  Liver,  page  76. 


Abscess  of  Liver. 

Line  of  liver  dulness  well  marked. 
Line  of  dulness  corresponds  to  the 

hepatic  area. 
Shiny,  oedematous  skin  over  liver 

appears  late  in  the  disease. 
Superficial    tenderness   over    liver 

appears  late. 
The  tumor  has   an  up   and  -down 

movement,  due  to  respiration. 

Abscess  of  Liver. 

History  of  injury,  dysentery,  etc. 

Abscess  tumor  broad  and  flat. 

Tumor  not  movable. 

Chills,  fever,  and  sweating. 

J  aundice  uncommon. 

Melancholia. 

Exploring  needle  withdraws  pus. 

Abscess  of  Liver. 


1.  Chills,  fever,  and  sweating. 

2.  Temperature,  103''  to  105°. 

3.  Gastric  symptoms. 

4.  Deep  fluctuation  on  palpation. 


Abscess  in  Abdominal  Wall. 

1.  Line  of  dulness  indistinct. 

2.  Line    of    dulness    does   not   corre- 

spond to  liver  dulness. 

3.  Inflammation  of  the  skin  appears 

early  in  the  disease. 

4.  Superficial      tenderness      appears 

early. 

5.  The  tumor  has  no  up   and  down 

movement. 

Enlarged  Gall  Bladder. 

1.  History  of  jaundice  or  biliary  colic. 

2.  Tumor  globular  and  pear-shaped. 

3.  Tumor  movable. 

4.  No  chills  or  sweating. 

5.  Jaundice  common. 

6.  No  depression  of  spirits. 

7.  Exploring  needle  withdraws  bile. 


Perihepatitis. 

No  chills  or  sweating. 
Temperature  rarely  over  10: 
No  gastric  disturbance. 
No  fluctuating  tumor. 


8o 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Abscess  of  Liver. 

5.  Increased  area  of  liver  dulness  on 

percussion. 

6.  Patient  has  a  hectic  appearance. 

7.  Melancholia. 

Abscess  of  Liver. 

1.  Diarrhoea  uncommon. 

2.  Jaundice  infrequent. 

3.  Fluctuation  on  palpation. 

4.  Spleen  normal  size. 

5.  No  enlargement  of  abdominal  veins. 

6.  Stools  clay-colored. 

7.  Exploring  needle  withdrav^s  pus. 

Abscess  of  Liver. 

1.  Gastric  disturbance. 

2.  Stools  clay-colored. 

3.  Needle  thrust  into  liver  abscess  has 

an  up-and-down  movement. 

4.  Area   of    dulness    corresponds    to 

that  of  enlarged  liver. 

5.  Dulness  seldom  reaches  above  the 

fourth  rib. 

6.  Disease  preceded  by  signs  of  he- 

patic inflammation. 

7.  Marked  tenderness  over  liver  area. 

8.  No  pulmonary  symptoms. 

9.  Exploring  needle  will  bring  away 

hepatic  tissue. 

Acute  Yellow  Atrophy. 

1.  Begins  as  simple  jaundice. 

2.  No  chill  with  sudden  rise  of  tem- 

perature. 


DISEASES   TO    BE   DIFFERENTIATED. 

Perihepatitis. 

5.  Liver  not  enlarged. 

6.  Patient  has  a  normal  appearance. 

7.  Buoyant  spirits. 

Pylephlebitis. 

1 .  Diarrhoea. 

2.  Jaundice. 

3.  No  fluctuating  tumor. 

4.  Spleen  enlarged. 

5.  Abdominal  veins  distended. 

6.  Stools  watery  and  dark. 

7.  Exploring  needle  withdraws  blood. 

Empyema. 

1.  No  gastric  symptoms. 

2.  Stools  normal  color. 

3.  Needle  thrust  into  plural  cavity  has 

no  up-and-down  movement.    - 

4.  Area  of  dulness  changes  with  the 

position  of  patient. 

5.  Flatness  often  extends  higher  than 

the  fourth  rib. 

6.  Disease    preceded   by   pleurisy    or 

pleuro-pneumonia. 

7.  No  tenderness  on  pressure. 

8.  Cough,    dyspnoea,    and   expectora- 

tion. 

9.  Exploring  needle  withdraw^s  pus. 

Bilious  Remittent  Fever. 

1.  Begins  with  a  chill. 

2.  Chills     followed     by     fever     and 

sweating. 


DISEASES  OF  THE  LIVER. 


8i 


NAME   OF    DISEASE. 

Acute  Yellow  Atrophy. 

3.  No   regular   remissions   of     symp- 

toms. 

4.  No  pigmentation  of  blood. 

5.  Jaundice  appears  early. 

6.  Liver  diminishes  in  size. 

7.  Leucin  and  tyrosin  in  urine. 

Acute  Yellov/  Atrophy. 

1.  Temperature  elevated. 

2.  Liver  diminishes  in  size. 

3.  Stupor,  coma,  and  convulsions. 

4.  Severe  headache. 

5.  Leucin  and  tyrosin  in  urine. 

6.  Pulse  rapid  from  140  to  160. 


Acute  Yellow  Atrophy. 

Begins  as  simple  jaundice. 

Spleen  increased  in  size. 

Liver  diminishes  in  size. 

Urine  acid. 

Urine  contains  leucin  and  tyrosin. 

6.  Pulse  140  to  160. 

7.  "  Black  vomit  "  appears  late. 

Acute  Yellow  Atrophy. 

1.  Begins  as  simple  jaundice. 

2.  No  chills  or  exhaustive  sweats. 

3.  Stools  clay-colored  and  formed. 

4.  Liver  diminishes  rapidly  in  size. 

5.  Leucin  and  tyrosin  in  urine. 

6.  No  lung  complications. 


DISEASES    TO    BE   DIFFERENTIATED. 

Bilious  Remittent  Fever. 

3.  Regular  remission  of  symptoms. 

4.  Free  pigment  in  blood. 

5.  Jaundice  appears  late. 

6.  Liver  increases  in  size. 

7.  Urine  normal. 

Simple  Obstructive  Jaundice. 

1.  Temperature  normal. 

2.  Liver  slightly  increased  in  size. 

3.  Mind  dull. 

4.  Dull  frontal  headache. 

5.  Bile  pigment  in  urine. 

6.  Pulse  full  and  slow. 

Yellow  Fever. 

1.  Begins  with  a  chill. 

2.  Spleen  normal  in  size. 

3.  Liver  increases  in  size. 

4.  Urine  alkaline. 

5.  Urine  contains  many  urates. 

6.  Pulse  gaseous  and  rarely  over  iio. 

7.  "  Black  vomit  "  appears  early. 

Pyaemia. 

1.  Begins  with  a  chill. 

2.  Irregular  chills  and  sweating. 

3.  Diarrhoea. 

4.  Liver  normal  in  size. 

5.  Urine  albuminous. 

6.  Abscess  of  lungs. 


Acute  Yellow  Atrophy.  Remittent  Fever, 

See  Remittent  Fever,  page  80. 


82 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 


DISEASES   TO    BE   DIFFERENTIATED. 


Fatty  Liver.  Acute  Congestion  of  Liver. 

See  Actite  Congestion  of  Liver,  page  77. 


Fatty  Liver. 

1.  History  of  high  living  or  phthisis. 

2.  Skin  shiny  and  greasy. 

3.  Blood  hydroaemic. 

4.  Urine  normal. 

5.  Liver  feels  soft  and  flabby. 

6.  Spleen  normal  in  size. 

Fatty  Liver. 

1.  History  of  high  living  or  phthisis. 

2.  Liver  uniformly  enlarged. 

3.  No  pain  over  liver. 

4.  Skin  shiny  and  greasy. 

5.  Slow  progress  of  disease, 

6.  No  enlarged  glands. 

Cancer  of  Liver. 


Waxy  Liver. 

1.  History  of  suppuration  or  syphilis. 

2.  Skin    pale    and    dry   with   indigo 
odor. 

3.  Blood  leukaemic. 

4.  Urine  albuminous. 

5.  Liver  feels  hard  and  well  defined. 

6.  Spleen  increased  in  size. 

Cancer  of  Liver. 

1.  History  of  hereditary  or  secondary 

cancer. 

2.  Nodular  enlargement  of  liver. 

3.  Severe  pain  over  liver. 

4.  Skin  dry  and  straw-colored. 

5.  Disease  rapid  in  progress. 

6.  Abdominal  and  cervical  glands  en- 

larged. 

Cirrhosis  of  Liver. 


See  Cirrhosis  of  Liver,  page  77. 

Cancer  of  Liver.  Fatty  Liver. 

See  Fatty  Liver,  above. 

Cancer  of  Liver.  Abscess  of  Liver. 

See  Abscess  of  Liver,  page  78. 

Cancer  of  Liver.  Hydatids  of  Liver. 

I.  Pain  severe.  i.  No  pain. 


2.   Liver  nodules  hard. 


2.   Liver    tumors    soft,     smooth    and 
elastic. 


DISEASES  OF  THE  LIVER. 


83 


NAME   OF   DISEASE. 

Cancer  of  Liver. 

3.  No  percussion  fremitus. 

4.  Severe  gastric  symptoms. 

5.  Disease  rapid  in  development. 

6.  Exploring  needle  withdraws  blood. 


Cancer  of  Liver. 

1.  Hepatic  symptoms  appear  first 

2.  No  vomiting  of  blood. 

3.  Gastric  symptoms  not  increased  by 

taking  food. 

4.  Absolute  dulness  over  the  tumor. 

5.  Tumor  multiple. 

6.  Tumor  stationary. 

Cancer  of  Liver. 

1.  Gastric  symptoms  well  marked. 

2.  Urine  normal. 

3.  Outline  of  dulness    corresponds  to 

the  shape  of  the  liver. 

4.  Area  of  dulness  not  bounded  by  a 

tympanitic  resonance. 

5.  Tumor  lowered  by  a  deep  inspira- 

tion. 

6.  Disease  of  adults. 


DISEASES   TO   BE   DIFFERENTIATED. 

Hydatids  of  Liver. 

3.  Hydatid  fremitus  on  percussion. 

4.  No  gastric  disturbance. 

5.  Slow  progress  of  disease. 

6.  Exploring  needle  withdraws   fluid 

containing  hooklets. 

Cancer  of  Stomach. 

1.  Gastric  symptoms  are  the   first  to 

appear. 

2.  Hematemesis. 

3.  Symptoms  often  increased  by  tak- 

ing food. 

4.  Tympanitic  quality  to   the   tumor 

dulness. 

5.  Tumor  single. 

6.  Tumor  movable. 

Cancer  of  Kidney. 

1.  No    well-marked    gastric    disturb- 

ance. 

2.  Urine  contains  blood. 

3.  Outline  of  dulness   corresponds  to 

the  shape  of  the  kidney. 

4.  Area   of    dulness    is   bounded    by 

tympanitic  resonance. 

5.  Tumor  stationary. 

6.  disease  of  children  or  adults. 


Hydatids  of  Liver.  Cancer  of  Liver. 

See  Cancer  of  Liver,  page  82. 

Hydatids  of  Liver.  Abscess  of  Liver. 

See  Abscess  of  Liver,  page  78. 


84 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF  DISEASE.  DISEASES   TO    BE   DIFFERENTIATED. 

Hydatids  of  Liver.  Abdominal  Aneurism. 

See  Abdominal  Aneurism^  P^^ge  46. 


Hydatids  of  Liver.  ^ 

1.  History  of  eating  raw  meat. 

2.  Tumor  multiple. 

3.  Tumor  globular. 

4.  Tumor  readily  manipulated. 

5.  Hydatic  fremitus  on  percussion. 

6.  Exploring    needle  withdraws  fluid 

containing  booklets. 

Hydatids  of  Liver. 

1.  Tumor   grows    from   above   down- 

ward. 

2.  Tumor  rises  and  falls  with  respira-  ^ 

tion. 

3.  Colon  lies  behind  tumor. 

4.  Hydatid  fremitus  on  percussion. 

5.  Hooklets  found  in  aspirated  fluid 

from  tumor. 


I. 


Enlarged  Gall  Bladder. 

of    jaundice    or    hepatic 


History 
colic. 

2.  Tumor  single. 

3.  Tumor  pear-shaped. 

4.  Tumor  not  readily  manipulated. 

5.  No  fremitus  on  percussion. 

6.  Exploring  needle  withdraws  bile. 

Cyst  of  Kidney. 

1.  Tumor  grows  from  below  upward. 

2.  Tumor  stationary. 

3.  Colon  lies  in  front  of  tumor. 

4.  No  fremitus  on  percussion. 

5.  Aspirating  needle  withdraws  albu- 

minous fluid  containing  chlorides. 


Hydatids  of  Liver.  Ascites. 

See  Ascites y  page  72. 
Perihepatitis.  Abscess  of  Liver. 

See  Abscess  of  Liver,  page  79. 


Perihepatitis. 

Begins  with  a  chill.  i. 

Temperature  100°  to  102°.  2. 

No  distinct  points  of  tenderness.  3. 

No  history  of  neuralgia.  4. 

Pain  not  limited  to  an  intercostal  5. 
space. 


Intercostal  Neuralgia. 

Begins  with  shooting  pain  in  side. 
Temperature  normal. 
Three  distinct  points  of  tenderness. 
History  of  neuralgia. 
Pain    limited    to     an     intercostal 
space. 


DISEASES  OF  THE  LIVER. 


85 


NAME   OF   DISEASE. 

Perihepatitis. 

6.  Pain  increased  by  pressure  upward 

under  ribs. 

7.  No  herpetic  eruptions. 

Perihepatitis. 

1.  Slight  dyspnoea. 

2.  Pain  increased  by  pressure  upward 

under  ribs. 

3.  Pain  most  severe  below  fourth  rib. 

4.  Pulmonary  physical  signs  normal. 


5.   No  cough. 


DISEASES   TO   BE   DIFFERENTIATED. 

Intercostal  Neuralgia. 

6.  Pain  not  increased  by  pressure  up- 

ward under  ribs. 

7.  Herpes  zoster  common. 

Acute  Pleurisy. 

1.  Dyspnoea  well  marked. 

2.  Pain    not    increased   by   pressure, 

but  by  respiration. 

3.  Pain  most  severe  above  fourth  rib. 

4.  Diminished  vocal  fremitus,  dulness 

on  percussion,  and  sticky  rales. 

5.  Teasing  dry  cough. 


Hepatic  Colic.  Intestinal  Colic. 

See  Intestinal  Colic,  page  67. 

Hepatic  Colic.  Acute  Peritonitis. 

See  Acute  Peritonitis,  page  69. 


Hepatic  Colic. 

1.  Pain  shoots  from  gall  bladder  to 

back. 

2.  Urine  contains  bile  pigment. 
Faeces  clay-colored. 
Stools  contain  gall-stones. 
Urine  voided  naturally. 
Gall   bladder    remains  tender   on 

pressure. 

Hepatic  Colic. 

1.  Attack  comes  on  at  any  time. 

2.  Pain  shoots  from  gall  bladder  to 

back. 

3.  Pain  ceases  suddenly. 

4.  Urine  contains  bile  pigment. 

5.  Faeces  clay-colored. 


Renal  Colic. 

1.  Pain  shoots  along  ureter  to  testicle 

or  penis. 

2.  Urine  contains  blood. 

3.  Faeces  normal  color. 

4.  Urine  contains  gravel. 

5.  Urine  passed  every  few  minutes. 

6.  Sharp  pain  followed  by  a  dull  ach- 

ing in  loins. 

Cardialgia. 

1.  Attack  comes  on  after  eating. 

2.  Pain  confined  to  epigastric  region. 

3.  Pain  stops  gradually. 

4.  Urine  normal, 

5.  Normal  color  of  fasces, 


86 


DIFFERENTIAL  DIAGNOSIS. 


NAME   OF   DISEASE. 

Hepatogenous  Jaundice. 

1.  Occurs  with  gastroduodenitis,  ca- 

tarrh of  bile  ducts,  etc. 

2.  Urine  contains  bile  coloring  mat- 

ter. 

3.  No  albumen  in  urine. 

4.  Faeces  clay-colored. 

5.  Heart  slow  and  regular. 

6.  No  severe  nervous  symptoms. 

7.  Itching  of  skin. 

8.  Liver  increased  in  size. 

9.  Jaundice  well  marked. 
10.  Slight  loss  of  flesh. 


DISEASES  TO   BE  DIFFERENTIATED. 

Hematogenous  Jaundice. 

1.  Occurs  with  fevers,    blood    dis- 

eases, etc. 

2.  Urine  contains  bile  acids. 

3.  Urine  albuminous. 

4.  Faeces  dark  color. 

5.  Heart  rapid  and  irregular. 

6.  Nervous  symptoms  well  marked. 

7.  Small  hemorrhages  in  skin. 

8.  Spleen  usually  enlarged. 

9.  Jaundice  slight. 
ID.  Rapid  emaciation. 


Hepatogenous  Jaundice.  Acute  Yellow  Atrophy. 

See  Acute  Yellow  Atrophy,  page  81. 

Hepatogenous  Jaundice.  Acute  Congestion  of  Liver. 

See  Acute  Congestion  of  Liver,  page  77. 


DIFFERENTIAL   DIAGNOSIS    OF    THE    DISEASES    OF 
THE  KIDNEYS  AND  BLADDER. 


DIFFERENTIAL    DIAGNOSIS  OF   THE    DISEASES    OF 
THE  KIDNEYS  AND  BLADDER. 


NAME   OF   DISEASE. 


Uraemia     .         .         .         . 


Acute  Bright's   . 


Large  White  Kidney 

(Chronic  Bright's) 


Cirrhotic  kidney 

(Chronic  Bright's) 


Fatty  or  waxy  kidney 

(Chronic  Bright's) 

Bright's  disease  (dropsy)     . 


DISEASES    TO   BE   DIFFERENTIATED. 

^  Epilepsy. 
Apoplexy. 
Hysteria. 
Meningitis. 

Opium  poisoning. 
.  Alcoholic  coma. 

Congestion  of  the  kidneys. 
Hematinuria. 
Suppurative  nephritis. 
Acute  cystitis. 
_  Chronic  Bright's. 

Acute  Bright's. 
Cirrhotic  kidney. 
Fatty  or  waxy  kidney. 

Acute  Bright's. 
Large,  white  kidney. 
Fatty  or  waxy  kidney. 

Acute  Bright's. 
Cirrhotic  kidney. 
Large  white  kidney. 


Dropsy  due  to  other  causes, 


89 


90 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF   DISEASE. 

Pyelitis      .... 
Pyonephrosis     . 

Suppurative  nephritis 

Hematuria 
Hematinuria 

Hydronephrosis,  or  hydatids 


Cancer  of  kidney 


Perinephritic  abscess 


Renal  calculi      .         ,         , 


DISEASES   TO   BE  DIFFERENTIATED. 

(   Suppurative  nephritis. 
(  Cystitis. 

j  Perinephritic  abscess. 
\.  Hydronephrosis. 

Pyelitis. 

Pysemia. 
^    Perinephritic  abscess. 

Acute  B right's. 
1^  Cystitis. 

j   Hemorrhage  from  bladder. 
'   Hemorrhage  from  urethra. 

j   Acute  Bright's. 
\   Hematuria. 

Hydatids  of  kidney. 
Ovarian  cyst. 
Pyonephritis. 
Cancer  of  kidney. 
Perinephritic  abscess. 
Hydatids  of  liver. 

'  Perinephritic  abscess. 

Tumor  of  liver. 

Tumor  of  spleen. 

Abdominal  aneurism. 

Hydronephrosis,  or  Hydatids. 
,  Tubercle  of  kidney. 

Pyonephritis. 
Suppurative  nephritis. 
Cancer  of  kidney. 
Hydronephrosis. 

Acute  peritonitis. 
Hepatic  colic. 
Intestinal  colic. 


DISEASES  OF  THE  KIDNEYS  AND  BLADDER. 


91 


NAME    OF   DISEASE. 


Cystitis 


'  Uraemia. 

1.  History  of  Bright's  disease. 

2.  CEdema. 

3.  Convulsions  migratory  in  charac- 

ter. 

4.  No  change  in  pupils. 

5.  No  biting  of  tongue. 

6.  Waxy  countenance. 

7.  Albumen  and  casts  in  urine. 

8.  Temperature  low. 

g.   Deep  coma  follows  convulsions. 
10.   No  initial  cry  or  pallor. 

Uraemia. 

1.  History  of  Bright's  disease. 

2.  Coma  follows  convulsions. 

3.  Stertor  sharp  and  hissing. 

4.  No  paralysis. 

5.  Urine  albuminous  with  casts. 

6.  Pupils  normal. 

7.  General  oedema. 

8.  Patient  has  a  uriniferous  smell. 

Uraemia. 

1.  History  of  Bright's. 

2.  Convulsions  appear  without  warn- 

ing and  followed  by  coma. 

3.  Peculiar  stertor. 

4.  Casts  and  albumen  in  urine. 
5    Reflexes  absent. 


DISEASES   TO   BE   DIFFERENTIATED. 

'  Acute  Bright's. 
Pyelitis. 

Suppurative  Nephritis. 
Spasm  of  the  bladder. 

Epilepsy. 

1.  History  of  epilepsy. 

2.  No  general  oedema. 

3.  Convulsions   general — tonic   then 

clonic. 

4.  Dilated  pupils  follow  spasm. 

5.  Tongue  bitten. 

6.  Countenance  cyanotic. 

7.  Urine  normal. 

8.  Temperature  elevated, 
g.   Mild  coma  or  sleep. 

10.  Initial  cry  and  pallor. 

Apoplexy. 

1.  History    of     disease    of     arteries, 

heart,  or  of  injury. 

2.  Coma  precedes  convulsions. 

3.  Stertor  labored  and  snoring. 

4.  Paralysis  and  spasm  of  one  side. 

5.  Urine  normal. 

6.  Pupils  unequal. 

7.  No  oedema. 

8.  No  smell  about  patient. 

Hysteria. 

1.  History  of  hysteria. 

2.  Coma   alternates  with  convulsions 

and  other  hysterical  symptoms. 

3.  Breathing  free  from  stertor. 

4.  Urine  pale  and  abundant. 

5.  Reflexes  pale  or  exaggerated. 


92 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Uraemia. 

6.  Opisthotonos  rare. 

7.  Cervical  vessels  distended. 

8.  Moral  treatment  has  no  effect. 

Uraemia. 

1.  History  of  Bright's. 

2.  General  oedema. 

3.  Pulse  rapid. 

4.  Waxy  countenance. 

5.  Temperature  highest  at  first. 

6.  Convulsions  migratory  in  charac- 

ter. 

7.  Odor  of  urine  about  patient. 

8.  Albumen  and  casts  in  urine. 

9.  Delirium  usually  mild  or  absent. 

Uraemia. 

1.  History  of  Bright's. 

2.  Coma  preceded  by  other  symptoms. 

3.  Respiration  hurried. 

4.  Pupils  normal. 

5.  Casts  and  albumen  in  urine.  • 

6.  CEdema. 

7.  SmeU  of  urine  about  patient. 

8.  Skin  dry  and  v^axy  in  appearance. 

Uraemia. 

1.  History  of  Bright's. 

2.  Cannot  be  aroused. 

3.  Albumen  and  casts  in  urine. 

4.  Uriniferous  smell  about  patient. 

5.  Face  waxy. 

6.  CEdema, 

7.  Stertor  hissing  in  character. 


DISEASES   TO   BE   DIFFERENTIATED. 

Hysteria. 

6.  Opisthotonos  common. 

7.  No  distended  veins. 

8.  Moral  treatment  curative. 

Meningitis. 

I.'  History  of  injury  or  disease. 

2.  No  oedema. 

3.  Pulse  slow. 

4.  Flushed  face. 

5.  Temperature  rises  from  day  to  day. 

6.  Convulsions  not  characteristic. 

7.  No  odor  about  patient. 

8.  Urine  normal. 

9.  "Wild  delirium. 

Opium  Poisoning. 

1.  No  previous  history. 

2.  Coma  comes  on  gradually  like  sleep. 

3.  Respiration  slow. 

4.  Pupils  contracted. 
4.  Urine  normal. 

6.  No  oedema. 

7.  Often  smell  of  opium  in  breath. 

8.  Profuse  sweating,  countenance  cy- 

anosed. 


Alcoholic  Coma. 

History  of  alcoholism. 

Aroused  momentarily  by  pain. 

Urine  contains  alcohol. 

Smell  of  alcohol  in  breath. 

Face  flushed. 

No  oedema. 

Stertor  "  puffy"  in  character. 


DISEASES  OF  THE  KIDNEYS  AND  BLADDER. 


93 


NAME   OF   DISEASE.. 

Acute  Bright's  Disease. 

1.  History  of   acute    disease,   expos- 

ure to  cold,  etc. 

2.  Severe  constitutional  symptoms  as 

headache,  vomiting,  etc. 

3  High  specific  gravity  of  urine. 

4.  Urine  very  albuminous. 

5.  Casts  in  urine. 

6.  Urine  bloody. 

7.  Temperature  elevated. 

8.  Dropsy  well  marked. 

Acute  Bright's. 

1.  Dropsy. 

2.  Disease  lasts  for  some  time. 

3.  Small  amount  of  blood  in  urine. 

4.  Severe  constitutional  symptoms. 

5.  No  granular  pigment  in  urine. 

6.  Much  albumen  and  many  casts  in 

urine.  ' 

Acute  Bright's. 

1.  Affects  both  kidneys. 

2.  Casts  abundant. 

3.  Pus  small  in  amount. 

4.  Kidneys  not  enlarged. 

5.  Continued  fever. 

6.  Severe  backache. 

7.  Dropsy. 

Acute  Bright's. 

1.  Pain  in  back. 

2.  Pain  not  very  severe. 

3.  Slight  pain  in  passing  water. 


DISEASES  TO   BE  DIFFERENTIATED. 

Congestion  of  Kidney. 

1.  History  of  venous  obstruction. 

2.  No    severe    constitutional    symp- 

toms. 

3.  Specific  gravity  of  urine  normal. 

4.  But  little  albumen  in  urine. 

5.  No  casts  in  urine. 

6.  No  blood  in  urine. 

7.  Temperature  normal. 

8.  No  general  oedema. 

Hematinuria. 

1.  No  general  oedema. 

2.  Disease  of  short  duration. 

3.  Blood  in  large  amount. 

4.  No   severe  constitutional  disturb- 

ance. 

5.  Granular  pigment  in  urine. 

6.  But  little  albumen  and  few  blood- 

casts  in  urine. 

Suppurative  Nephritis. 

1.  Affects  one  kidney. 

2.  Casts  few  and  covered  with  pus. 

3.  Large  amount  of  pus  in  urine. 

4.  Affected  kidney  enlarged  and  ten- 

der. 

5.  Fever  remittent. 

6.  Pain  localized  over  one  kidney. 

7.  No  general  oedema. 

Acute  Cystitis. 

1.  Pain  over  bladder  and  in  penis. 

2.  Pain  sharp  and  burning. 

3.  Burning  pain  on  urinating. 


94 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE. 

Acute  Bright's. 

4.  Albumen  large  in  amount. 

5.  But  little  pus  and  mucus  in  urine. 


6.  Urine  bloody. 

7.  Casts  in  urine. 

8.  Dropsy. 

9.  Constitutional 

marked. 


symptoms      well 


DISEASES   TO   BE   DIFFERENTIATED. 

Acute  Cystitis. 

4.  But  little  albumen  in  urine. 

5.  Much     ropy   pus    and    mucus    in 

urine. 

6.  Bloody  urine  uncommon. 

7.  No  casts  in  urine. 

8.  No  general  oedema. 

9.  Less  severe  constitutional  disturb- 

ances. 


Acute  Bright's.  Chronic  Bright's. 

See  Chronic  Bright* s,  pages  94,  95,  96. 


Large  White  Kidney. 

(Chronic  Bright's.) 

1.  Usually  the  result  of  acute  Bright's. 

2.  Heart  hypertrophied. 

3.  Urine  normal,  or  slightly  increased 

in  amount. 

4.  Casts — ^hyaline,  granular,  and  epi- 

thelial. 

5.  Specific  gravity    of    urine   dimin- 

ished. 

6.  No  blood  in  urine. 

7.  Temperature  normal. 

Large  White  Kidney. 

1.  Dropsy  well  marked. 

2.  Most  common  in  young  adults. 

3.  Amount     of     urine     normal,     or 

slightly  increased. 

4.  Epistaxis  and  retinitis  uncommon. 

5.  Specific    gravity    of    urine,   loio- 

1018. 


Acute  Bright's. 


1.  Usually  the  result  of  exposure  to 

cold  or  some  acute  disease. 

2.  Heart  normal. 

3.  Urine  diminished  in  amount. 

4.  Blood  and  a  few  hyaline  casts  in 

urine. 

5.  Specific  gravity  of  urine  increased. 

6.  Urine  bloody. 

7.  Temperature  elevated. 

Cirrhotic  or  Atrophied  Kidney. 

1.  Little  or  no  general  oedema. 

2.  The  nephritis  of  adults. 

3.  Amount     of     urine     greatly     in- 

creased. 

4.  Epistaxis  and  retinitis  common. 

5.  Urine  low  specific  gravity,    1005- 

lOIO. 


DISEASES  OF  THE  KIDNEYS  AND  BLADDER, 


95 


NAME   OF   DISEASE. 

Large  White  Kidney. 

6.  Many  casts  in  urine. 

7.  Liver  normal  size. 

8.  Much  albumen  in  urine. 

Large  White  Kidney. 

1.  Usually  the  result  of  acute  Bright's. 

2.  Dropsy  comes  on  rapidly. 

3.  Uraemic  symptoms  common. 

4.  Liver  and  spleen  normal  size. 

5.  Diarrhoea  unfrequent. 

6.  Casts  :  hyaline,  granular,  and  epi- 

thelial. 

7.  Face  pale. 

Cirrhotic  Kidney. 

(Chronic  Bright's.) 

1.  CEdema  slight. 

2.  Disease  of  slow  progress. 

3.  Urine  increased  in  amount. 

4.  Urine  of  low  specific  gravity. 

5.  No  blood  in  urine. 

6.  Few  casts — hyaline  and  granular. 

7.  No  acute  symptoms  at  first. 

Cirrhotic  Kidney. 

See  Large  White 

Cirrhotic  Kidney. 

1.  History  of  previous  good  health. 

2.  Little  or  no  dropsy. 

3.  Liver  small. 


DISEASES  TO   BE   DIFFERENTIATED. 

Cirrhotic  or  Atrophied  Kidney. 

6.  Few  casts,  principally  hyahne. 

7.  Liver  small. 

8.  Little  or  no  albumen  in  urine. 

Fatty  or  Waxy  Kidney. 

1.  Follows  wasting  disease  and  sup- 

puration. 

2.  Gradual  development  of  oedema. 

3.  Uraemic  symptoms  uncommon, 

4.  Liver  and  spleen  enlarged. 

5.  Obstinate  diarrhoea. 

6.  Fatty  and  waxy  casts  in  urine. 

7.  Face  wax-like. 

Acute  Bright's. 

1.  Dropsy  well  marked. 

2.  Disease  rapid  in  progress. 

3.  Urine  diminished  in  amount. 

4.  Specific  gravity  of  urine  high. 

5.  Bloody  urine. 

b.  Blood  and  hyaline  casts. 
7.  Symptoms  acute  from   the  begin- 
ning. 

Large  White  Kidney. 

Kidney,  page  94. 

Fatty  or  Waxy  Kidney. 

1.  History  of  wasting  disease  or  sup- 

puration. 

2.  CEdema  well  marked. 

3.  Liver  large. 


96 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE.   , 

Cirrhotic  Kidney. 
Specific  gravity  of  urine  1,005  to 

1,010. 

But  little  albumen  in  urine. 
Few  hyaline  and  granular  casts. 
Sallow  complexion. 

Fatty  or  Waxy  Kidney. 


DISEASES  TO   BE  DIFFERENTIATED. 

Fatty  or  Waxy  Kidney. 

4.  Specific  gravity  of  urine  i,0TO  to 

1,015. 

5.  Much  albumen  in  urine. 

6.  Fatty  and  waxy  casts. 

7.  Waxy  countenance. 

Large  White  Kidney. 


See  Large  White  Kidney,  page  95. 

Fatty  or  Waxy  Kidney.  Cirrhotic  Kidney. 

See  Cirrhotic  Kidney,  above. 

Fatty  or  Waxy  Kidney.  Acute  Bright's. 


(Chronic  Bright's.) 

1.  History  of  wasting  disease  or  sup- 

puration. 

2.  Symptoms  appear  slowly. 

3.  Urine  increased  in  amount. 

4.  No  blood  in  urine. 

5.  Fatty  and  waxy  casts. 

6.  Ursemic  symptoms  rare. 

7.  Temperature  normal. 

8.  Specific  gravity  of  urine  low. 

Bright's  Disease. 

(Dropsy.) 

1.  Dropsy  usually  begins  in  the  feet. 

2.  Urine  contains  albumen  and  casts. 

3.  Complexion  pale,  sallow,  or  waxy. 

4.  Urine  altered  in  amount  or  color. 

5.  Urine  altered  in  specific  gravity. 

6.  No  pulmonary  symptoms. 

7.  Pain  in  region  of  kidneys. 

8.  Uraemic  symptoms. 


I. 


History   of   exposure    to   cold  or 

some  acute  disease. 
Symptoms  come  on  rapidly. 
Urine  diminished 
Bloody  urine. 
Blood  and  hyaline  casts. 

6.  Urgemic  symptoms  common. 

7.  Temperature  elevated. 

8.  High  specific  gravity  of  urine. 

Dropsy  Due  to  Other  Causes. 

1.  Dropsy  begins  in  the   face  or  as 

ascites. 

2.  Urine  normal. 

3.  Complexion  cyanotic  or  cachectic. 

4.  Urine  normal  in  color  and  amount. 

5.  Specific  gravity  of  urine  normal. 

6.  Pulmonary  or  liver  symptoms  com- 

mon. 

7.  No  pain  over  kidneys. 

8.  Absence  of  uraemic  symptoms. 


DISEASES  OF  THE  KIDNEYS  AND  BLADDER. 


97 


NAME   OF   DISEASE. 

Pyelitis. 

1.  Constitutional  symptoms  not  very 

prominent. 

2.  No  recurring  chills  or  fever. 

3.  No  diarrhcea. 

4.  No  typhoid  symptoms. 

5.  Characteristic    "tailed"    cells    in 

urine. 

6.  No  tubal  pus  casts  in  urine. 

7.  Much  pus  constantly  in  urine. 

8.  Now  and  then  irregular  nephritic 

enlargement  (pyonephritis). 

Pyelitis. 

1.  Pain  in  lumbar  region. 

2.  Urine  acid. 

3.  Large  quantities  of  pus  in  urine. 

4.  "  Tailed  "  cells  in  urine. 

5.  No  constant  desire  to  urinate. 

6.  Much  foreign  matter  in  urine. 

7.  Little  mucus  in  urine. 

8.  No  pain  during  micturition. 

Pyonephrosis. 

1.  Pus,  blood,  and  mucus  in  urine. 

2.  Temperature  nearly  normal. 

3.  No  pain  on  motion. 

4.  "  Tailed  "  cells  in  urine. 

5.  Irregular  chills  and  sweating  un- 

common. 

6.  Tumor    appears     and     disappears 

suddenly. 

7.  No    signs    of    inflammation    over 

tumor. 


DISEASES   TO   BE   DIFFERENTIATED. 

Suppurative  Nephritis. 

1.  Constitutional  symptoms  severe. 

2.  Recurring  chills  and  fever. 

3.  Diarrhcea  common. 

4.  Typhoid  symptoms. 

5.  No  characteristic  cells  in  urine. 

6.  Pus  casts  of  renal  tubes  in  urine. 

7.  Pus    in   urine   inconstant    and   in 

small  amount. 

8.  Kidney    constantly    enlarged    and 

tender. 

Cystitis. 

1.  Pain  over  bladder  and  in  penis. 

2.  Urine  alkaline. 

3.  But  little  pus  in  urine. 

4.  No  characteristic  cells  in  urine. 

5.  Constant  desire  to  urinate. 

6.  But  little  foreign  matter  in  urine. 

7.  Urine  contains  large  quantities  of 

ropy  mucus. 

8.  Burning  pain  on  passing  water. 

Perinephritic  Abscess. 

1.  Urine  normal. 

2.  Temperature  elevated. 

3.  Severe  pain  on  motion. 

4.  No  characteristic  cells  in  urine. 

5.  Irregular  chills  and  profuse  sweat- 

ing at  intervals. 

6.  Tumor  constant. 

7.  Severe  pain  and  some  oedema  over 

tumor. 


98 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Pyonephrosis. 

1.  Urine  contains  mucli  pus,  etc.  i. 

2.  "  Tailed  "  cells  in  urine.  2. 

3.  Moderate  constitutional  symptoms,       3. 

as  pain,  debility,  etc. 

4.  Indistinct  fluctuation  of  tumor.  4. 

5.  Aspirating  needle  withdraws  pus,       5. 

etc. 


DISEASES   TO   BE   DIFFERENTIATED. 

Hydronephrosis. 

Urine  normal. 
No  cells  in  urine. 
General  health  good. 

Distinct  fluctuation  of  tumor. 
Aspirating    needle  withdraws  wa- 
tery urine. 


Suppurative  Nephritis. 

See  Pyelitis,  page  97. 


Pyelitis, 


Suppurative  Nephritis.  Acute  B  right's. 

See  Acute  Brighfsy  page  93. 


Suppurative  Nephritis. 

1.  No  profuse  sweating. 

2.  Urine  purulent  and  bloody. 

3.  Temperature  moderately  high. 

4.  No  joint  affections. 

5.  No  pulmonary  symptoms. 

6.  Affected     kidney      enlarged     and 

tender. 

7.  Severe  lumbar  pains. 

Suppurative  Nephritis. 

1.  Urine  bloody  and  purulent. 

2.  No  distinct  renal  tumor. 

3.  Pus  casts  in  urine. 

4.  No  superficial  signs  of  inflamma- 

tion. 

5.  Kidneys  tender  on  pressure. 

6.  No  fluctuation. 

7.  Temperature  continues  elevated. 


Pyaemia. 

1.  Profuse  sweats. 

2.  Urine  normal. 

3.  Fever  very  high  at  times. 

4.  Large  joints  affected. 

5.  Pulmonary  symptoms. 

6.  Kidneys  not  enlarged  or  tender. 

7.  Pain  not  referred  to  lumbar  region. 

Perinephritic  Abscess. 

1.  Urine  normal. 

2.  A  distinct  tumor  in  lumbar  region. 

3.  No  casts  in  urine. 

4.  Superficial  tenderness  and  oedema. 

5.  Kidneys  painful  on  pressure. 

6.  Fluctuation. 

7.  Irregular  chills,  fever,  and  sweat- 
-      ing. 


DISEASES  OF  THE  KIDNEYS  AND  BLADDER.  99 

NAME   OF   DISEASE.  DISEASES   TO    BE   DIFFERENTIATED. 


Suppurative  Nephritis. 


Cystitis. 


1.  Urine  contains  much  pus  and  little  i.  Urine   contains  much  ropy  mucus 

mucus.  and  little  pus. 

2.  Pain  in  lumbar  region.  2.  Pain  in  bladder  and  penis. 

3.  Pus  casts  in  urine.  3-  No  casts  in  urine. 

4.  Typhoid  symptoms  well  marked.  4.  No  severe  constitutional  symptoms. 

5.  No  constant  desire  to  urinate.  5.  Constant  desire  to  micturate. 

6-   Affected     kidney     enlarged     and  6.  Kidneys  not  enlarged  or  tender, 
tender. 


Hematuria. 


Vesical   Hemorrhage. 


1.  History   of  kidney  disease,  blood       i.   History  of  disease  of  the  bladder. 

disease,  poisoning,  etc. 

2.  Blood  mixed  with  the  urine.  2.  Blood  follows  the  passage  of  urine. 

3.  Urine  contains  albumen  and  blood       3.   Urine  contains  blood  clots. 

casts. 

4.  Pain  in  the  lumbar  region. 

5.  Renal  epithelium  in  urine. 


4.  Pain  located  in  bladder  or  penis. 

5.  Vesical  epithelium  in  urine. 


Hematuria. 


Urethral  Hemorrhage. 


I.   History  of  kidney  trouble,   blood       i.    History     of     urethritis,     prostatic 


disease  or  poisoning. 

2.  Blood  is  mixed  with  the  urine. 

3.  Urine  contains  albumen  and  blood 

casts. 

4.  Pain  in  the  lumbar  region. 

5.  Renal  epithelium  in  urine. 

6.  Blood  is  passed  with  urine. 


Hematinuria. 


trouble,  etc. 

2.  Blood   precedes     the  urinary   dis- 

charge. 

3.  Blood  casts  of  urethra  in  the  urine. 

4.  Pain  in  penis  or  prostate.- 

5.  No  renal  or  vesical  epithelium  in 

urine. 

6.  Blood  discharged  without  emptying 

the  bladder. 

Acute  Bright's. 


See  Acute  Bright' s,  page  93. 


100 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Hematinuria. 

1.  Often  the  result  of  malaria. 

2.  Few  red  blood  corpuscles  in  urine. 

3.  Abundance  of  blood  pigment  in 

urine. 

4.  Often  preceded  by  chilliness,  slight 

jaundice,  and  gastric  disorder. 

5.  Coloring  matter  not  deposited  on 

standing. 

6.  Urine  often  suddenly  changes  color 

on  standing. 

Hydronephrosis. 

1.  Urine  normal. 

2.  May  affect  both  kidneys. 

3.  No  fremitus  on  percussion. 

4.  Tumor  single. 

5.  Tumor  grows  rapidly. 

6.  Tumor  seldom  of  great  size. 

7.  Exploring     needle     withdraws     a 

watery  uriniferous  fluid. 

Hydronephrosis     or    Hydatids  of 
Kidney. 

1.  Tumor  grows  from  lumbar  region. 

2.  Colon  lies  in  front  of  tumor. 

3.  Vaginal  examination  negative. 

4.  Absence  of  tympanitic  percussion 

note  in  lumbar  region. 

5.  Exploring     needle     withdraws     a 

watery  fluid,  either  with  or  with- 
out hooklets. 


DISEASES    TO   BE   DIFFERENTIATED. 

Hematuria. 

1.  The  result  of  kidney  disease. 

2.  Many    red     blood    corpuscles    in 

urine. 

3.  No  free  blood  pigment  in  urine. 

4.  Preceded  by  pain  in  lumbar  region. 

5.  Coloring  matter  deposited  at  bot- 

tom of  vessel  on  standing. 

6.  Urine   does   not  change  color  on 

standing. 

Hydatids  of  Kidney. 

1.  Urine  contains  hydatid  vesicles. 

2.  Affects  one  kidney. 

3.  Hydatid  fremitus  on  percussion. 

4.  Tumor  multiple. 

5.  Tumor  grows  slowly. 

6.  Tumor  often  of  large  size. 

7.  Exploring  needle  withdraws  fluid 

containing  hooklets. 

Ovarian  Cyst. 

1.  Tumor  starts  from  pelvic  region. 

2.  Colon  behind  tumor. 

3.  Vaginal  examination  positive. 

4.  Tympanitic  percussion  in  lumbar 

region. 

5.  Exploring  needle  withdraws  albu- 

minous fluid  containing  character- 
istic cells. 


Hydronephrosis    or   Hydatids    of 
Kidney. 

See  Pyonephritis,  page  98. 


Pyonephritis. 


DISEASES  OF  THE  KIDNEYS  AND  BLADDER. 


lOI 


NAME    OF    DISEASE. 


Hydronephrosis    or    Hydatids    of 
Kidney. 

See  Hydatids  of  Liver,  page  84. 


DISEASES   TO    BE   DIFFERENTIATED. 


Hydatids  of  Liver. 


Hydronephrosis    or    Hydatids   ol 
Kidney. 

1.  Tumor  not  painful. 

2.  Tumor  grows  forward. 

3.  Superficial  fluctuation. 

4.  No  constitutional  symptoms. 

5.  No  signs  of  inflammation  about  the 

tumor. 

6.  Exploring  needle  withdraws  wat- 

ery fluid,   either  with  or  without 
hooklets. 

Hydronephrosis    or    Hydatids    of 
Kidney. 

1.  Tumor  not  painful. 

2.  No  constitutional  symptoms. 

3.  Tumor  smooth  and  fluctuating. 

4.  Urine  normal. 

5.  No  cachexia  or  history  of  cancer. 

6.  Exploring  needle  withdraws  watery 

fluid  v/ith  or  without  hooklets. 

Cancer  of  Kidney. 


Perinephritic  Abscess. 

1.  Tumor  painful. 

2.  Tumor  grows  backward. 

3.  Deep  fluctuation. 

4.  Chills,  fever,  and  sweating. 

5.  Tumor  painful   and  tender,    skin 

oedematous  and  sometimes  red. 

6.  Exploring  needle  withdraws  pus. 


Cancer  of  Kidney. 

1.  Tumor  painful. 

2.  Constitutional  symptoms. 

3.  Tumor  hard  and  nodular. 

4.  Urine   contains  blood  and   cancer 

cells. 

5.  Cachexia  and  often  history  of  can- 

cer. 

6.  Exploring  needle  withdraws  blood 

and  cancer  cells. 


Tumor  of  Liver. 

See  Tumor  of  Liver,  page  83. 

Cancer  of  Kidney.  Abdominal  Aneurism. 

See  Abdominal  Aneurism,  page  46. 

Cancer  of  Kidney.  Hydronephrosis    or    Hydatids    of 

Kidney. 

See  Hydronephrosis  or  Hydatids  of  Kidney,  above. 


102 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Cancer  of  Kidney. 

1.  History  of  hereditary  or  secondary 

cancer. 

2.  No  fluctuation. 

3.  No  chills  or  sweating. 

4.  No  paSi  on  pressure. 

5.  Slow  growth, 

6.  Urine  contains  blood  and   cancer 

cells. 

7.  Exploring  needle  withdraw^s  blood 

and  cancer  cells. 

Cancer  of  Kidney. 

1.  History  of  cancer. 

2.  Tumor  stationary. 

3.  Outline  of  tumor  irregular. 

4.  No  blood  changes. 

5.  Grows  from  lumbar  region. 

6.  Cancerous  cachexia, 

7.  Blood  and  cancer  cells  in  urine. 

Cancer  of  Kidney. 

1.  History  of  cancer. 

2.  Blood  in  urine. 

3.  No  tenderness  over  the  tumor, 

4.  No  disease  of  testicles  or  prostate. 

5.  No  pulmonary  symptoms. 

6.  Hectic  appears  late. 

7.  Tumor  grows  to  a  large  size. 


DISEASES   TO    BE   DIFFERENTIATED. 

Perinephritic  Abscess. 

1.  Often  a  history  of  injury  to  lumbar 

region. 

2.  Fluctuation  about  tumor. 

3.  Irregular  chills  and  profuse  sweats. 

4.  -Marked   pain    and   tenderness    on 

pressure. 

5.  Tumor  of  rapid  growth. 

6.  Urine  normal. 

7.  Exploring  needle  withdraws  pus. 

Tumor  of  Spleen. 

1.  History  of  malaria,  leucocythemia. 

2.  Tumor  moves  up  and  down  with 

the  breathing.  - 

3.  Outline    of     tumor  •  presents    the 

splenic  notch. 

4.  Large  increase  of  white  blood  cor- 

puscles. 

5.  Tumor  grows  from   the  left  hypo- 

chondriac region. 

6.  Patient  very  anaemic. 

7.  Urine  normal. 

Tubercular  Kidney. 

1.  History  of  tuberculosis. 

2.  Cheesy  debris  in  urine. 

3.  Tumor  tender  on  pressure. 

4.  Tubercular  disease  of  testicles  or 

prostate. 

5.  Lungs  phthisical. 

6.  Hectic  appears  early. 

7.  Tumor  rarely  of  large  size. 


DISEASES  OF  THE  KIDNEYS  AND  BIADDER.         IO3 

NAME   OF   DISEASE.  DISEASES   TO    BE   DIEFERENTIATED. 

Perinephritic  Abscess.  Pyonephritis. 

See  Pyonephritis,  page  97. 

Perinephritic  Abscess.  Suppurative  Nephritis. 

See  Suppurative  Nephritis,  page  98. 

Perinephritic  Abscess.  Cancer  of  Kidney. 

See  Cancer  of  Kidney,  page  102. 

Perinephritic  Abscess.  Hydronephrosis. 

See  Hydronephrosis ,  page  loi. 

Renal  Calculi.  Acute  Peritonitis. 

See  Acute  Peritonitis,  page  69. 
Renal  Calculi.  Hepatic  Colic. 

See  Hepatic  Colic,  page  85. 
Renal  Calculi.  Intestinal  Colic. 

See  Intestinal  Colic,  page  68. 

Cystitis.  Acute  Bright's. 

See  Acute  Bright' s,  page  94. 

Cystitis.  Pyelitis. 

See  Pyelitis,  page  97. 

Cystitis.  Suppurative  Nephritis. 

See  Suppurative  Nephritis,  page  99. 
Cystitis.  Spasm  of  the  Bladder. 

1.  Temperature  elevated.  i.  Temperature  normal. 

2.  Pain  burning  in  character.  2.  Pain  lancinating. 

3.  Pain  constant.  3.  Pain  paroxysmal. 

4.  Ropy  mucus  and  pus  in  urine.  4.   Urine  normal. 

5.  No  difficulty  in  passing  water  ex-  5.  Great  difficulty  in  passing  any  urine 

cept  the  pain.  during  the  paroxysm. 

6.  Urine  scalds.  6.  Urine  does  not  scald. 


DIFFERENTIAL   DIAGNOSIS  OF  THE  ACUTE    GEN- 
ERAL  DISEASES. 


DIFFERENTIAL   DIAGNOSIS    OF  THE  ACUTE   GEN- 
ERAL DISEASES. 


NAME   OF   DISEASE. 


Typhoid  fever 


Typhus  fever 


Yellow  fever 


Relapsing  fever 


Intermittent  fever 


DISEASES   TO    BE   DIFFERENTIATED. 

Typhus  fever. 
Typho-malarial  fever. 
Acute  tuberculosis. 
vSepticsemia. 

Ulcerative  endocarditis. 
Trichinosis. 
Acute  enteritis. 

'  Typhoid  fever. 
Relapsing  fever. 
Measles.  •-' 

Meningitis. 
Small-pox. 

f  Acute  yellow  atrophy  of  liver. 
I    Relapsing  fever. 
1    Typho-malarial  fever. 
Pernicious  malarial  fever. 

Yellow  fever. 
Typhus  fever. 
Remittent  fever. 
Dengue  fever. 


j   Pyaemia. 

i   Remittent  fever. 


107 


io8 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 


Remittent  fever 


Pernicious  malarial  fever 


DISEASES   TO    BE   DIFFERENTIATED. 

Intermittent  fever. 
Typhoid  fever. 
Yellow  fever. 
Relapsing  fever. 

Meningitis. 
Cholera. 
Yellow  fever. 


Small-pox 


Scarlet  fever 


Measles 


Cholera 


Diphtheria 


Epidemic  cerebro-spinal  meningitis 


Scarlet  fever. 

Measles.  ^ 

Epidemic  cerebro-spinal  meningitis. 

Varioloid. 

Chicken-pox. 

Typhus  fever. 

Measles. 
Variola. 
Erythema. 
Diphtheria. 

Variola. 
Scarlet  fever. 
Roseola. 
Typhus  fever. 

Acute  poisoning. 
Cholera  morbus. 
Pernicious  malarial  fever. 

Diphtheritic  sore  throat. 
Membranous  croup. 
Scarlet  fever. 
Erysipelas  of  throat. 

Small-pox. 
Typhus  fever. 
Tubercular  meningitis. 
Pernicious  fever. 


ACUTE  GENERAL  DISEASES. 


109 


NAME   OF   DISEASE, 


Pyaemia 


Septicaemia 


Hydrophobia 


DISEASES   TO    BE   DIFFERENTIATED. 

Suppurative  nephritis. 

Septicaemia. 

Intermittent  fever. 

Acute  yellow  atrophy  of  liver. 

Ulcerative  endo-carditis. 

Typhoid  fever. 
Pyaemia. 


.  J 


Tetanus. 
Hysteria. 


Typhoid  Fever. 

1.  Disease  endemic. 

2.  Advent  slow,  with  general  mala- 

ria, etc. 

3.  Chilly  sensations. 

4.  Temperature     characteristic     for 

each  week  of  the  disease. 

5.  Lenticular  rose-colored   eruption 

limited  to  abdomen. 

6.  Eruption  disappears  on  pressure. 

7.  Eruption  appears  from  seventh  to 

tenth  day. 

8.  Eruption  appears  in  crops. 

Q.  Diarrhoea. 

10.  Gurgling  and  tenderness  in  right 

iliac  fossa. 

11.  Epistaxis    and   intestinal   hemor- 

rhage common. 

12.  Nervous  symptoms  appear  in  the 

second  week. 

13.  Spleen  enlarged. 

14.  Face  flushed. 


Typhus  Fever. 


1.  Epidemic. 

2.  Advent  sudden. 

3.  Severe  chill. 

4.  Temperature  high  from  the  first. 

and  remains  so  until  crisis. 

5.  Irregular,  dark,  mottled  eruption 

appears     about    shoulders    and 
spreading  over  body. 

6.  Eruption  does  not    disappear  on 

pressure. 

7.  Eruption  appears  on  fifth  day. 

8.  Eruption    does    not     appear    in 

crops, 
g.   Constipation. 

10.  No  abdominal  symptoms. 

11.  Hemorrhages  very  uncommon, 

12.  Nervous  symptoms  appear  early. 

13.  Spleen  not  much  enlarged. 

14.  Face  mahogany  color. 


no 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF   DISEASE. 


DISEASES   TO   BE   DIFFERENTIATED. 


Typhoid  Fever. 

15.  Lasts  about  four  weeks. 

16.  No  crisis. 

17.  Bed-sores. 


Typhus  Fever. 

15.  Lasts  two  weeks. 

16.  Crisis  about  the  fourteenth  day. 

17.  Glandular  enlargements. 


Typhoid  Fever. 

1.  Onset  slow  with  chilly  sensations. 

2.  Temperature  rises  slowly  and  reg- 

ularly. 

3.  Characteristic  eruption. 

4.  No   jaundice    or  hepatic  tender- 

ness. 

5.  Spleen  somewhat  enlarged. 

6.  Abdomen  tympanitic. 

7.  Tenderness   and  gurgling  in  the 

right  iliac  fossa. 

8.  Gastric  symptoms  not  very  severe. 

9.  Diarrhcea  characteristic. 
10.   No  free  pigment  in  blood. 


Typho-malarial  Fever. 

1.  Onset  sudden  with  a  chill. 

2.  Temperature  rises  suddenly  and 

is  periodical  in  character. 

3.  No  eruption. 

4.  Jaundice  and  hepatic  tenderness. 


9- 
10. 


Spleen  greatly  enlarged. 

No  distension  of  abdomen. 

No  tenderness  or  gurgling  in  right 

iliac  fossa. 
Gastric       symptoms        especially 

marked. 
No  characteristic  diarrhoea. 
Free  pigment  in  blood. 


Typhoid  Fever. 

1.  Temperature  characteristic. 

2.  Eruption. 

3.  Typhoid  symptoms  appear  late. 

4.  No  jaundice. 

5.  GurgHng,  etc.,  in  right  iliac  fossa. 

6.  Nose  bleed. 

7.  History    of    exposure    to    typhoid 

poison. 


Septicaemia. 

1.  Temperature  very  high  and  irregu- 

lar from  first. 

2.  No  eruption. 

3.  Typhoid  symptoms  appear  early. 

4.  Jaundice. 

5.  No  iliac  symptoms. 

6.  No  nose  bleed. 

7.  History  of  injury  or  infectious  dis- 

ease. 


ACUTE  GENERAL  DISEASES. 


I  II 


NAME   OF    DISEASE. 

Typhoid  Fever. 

Disease  endemic. 

Temperature   highest   the    end    of 

second  week. 
Spleen  enlarged. 
Absence  of  dyspnoea. 
Bronchitis. 

Face  flushed. 
Characteristic  eruption. 
Choroid  normal. 
Sputum  not  characteristic. 

Typhoid  Fever. 

Temperature  characteristic. 

Eruption. 

No  oedema. 

No  severe  muscular  pains. 

No  muscular  tenderness. 

Examination  of  muscle  negative. 

Typhoid  Fever. 


DISEASES   TO   BE   DIFFERENTIATED. 

Acute  Tuberculosis. 

1.  Disease  hereditary  or  secondary, 

2.  Temperature    106"^  -  107''    in    first 

w^eek. 

3.  wSpleen  not  enlarged. 

4.  Severe  dyspnoea. 

5.  Lung    consolidation — suVjcrepitant 

rales. 

6.  Face  cyanosed. 

7.  No  eruption. 

8.  Tubercular  ulceration  of  choroid. 

9.  Sputum  contains  tubercle  bacilli. 

Trichinosis. 

1.  Temperature  not  characteristic. 

2.  No  eruption. 

8.  CEdema  of  eyelids. 

4.  Severe  muscular  pains. 

5.  Extreme  muscular  tenderness. 

6.  Trichinae  found  in  the  muscle. 

Ulcerative  Endocarditis. 


See  Ulcerative  Endocarditis ,   page  40. 

Typhoid  Fever.  Acute  Enteritis. 

See  Acute  Enteritis,  page  59. 
Typhus  Fever.  Typhoid  Fever. 

See  Typhoid  Fever,  page  109. 

Typhus  Fever.  Relapsing  Fever. 

Early  delirium.  i.   No  delirium. 


Mulberry  rash. 
Great  muscular  weakness. 
Spleen  normal  size. 
Crisis  on  fourteenth  day. 


2.   No  eruption. 

'3.  Severe  muscular  and  arthritic  pains. 

4.  Spleen  enlarged. 

5.  Intermission  end  of  first  week. 


112 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Typhus  Fever. 

6.  No  relapse. 

7.  No  profuse  sweats, 

8.  Pulse  not  very  rapid  at  first. 

9.  No  abdominal  symptoms. 

10,   Frequent  glandular  enlargement. 

Typhus  Fever. 


DISEASES   TO    BE   DIFFERENTIATED. 

Relapsing  Fever. 

6.  Relapse  end  of  second  week, 

7.  Severe  sweats. 

8.  Pulse  150  to  170  from  the  first. 

9.  Vomiting  and  abdominal  pain, 
10,   No  enlarged  glands. 

Small-pox. 


See  Small-pox,  page  118. 

Typhus  Fever.  Measles. 

Eruption     preceded     by    cerebral       i.  Eruption  preceded  by  symptoms  of 
symptoms     and     great     prostra- 
tion. 

Eruption  appears  on  the  fifth  day. 


3.  But  little  eruption  about  the  head. 
4. 


Eruption  not  crescentic  in  appear- 
ance. 

Eruption  dark-brown. 

Eruption   does   not    disappear    on       6.   Eruption  disappears  on  pressure, 
pressure. 


a  severe  cold. 

2.  Eruption    appears   on    the    fourth 

day. 

3.  Eruption   well-marked    about   the 

face. 

4.  Eruption  crescentic. 

5.  Eruption  dark-red. 


Mucous  membrane  of   throat  nor- 
mal. 

Typhus  Fever. 

Frontal  headache. 
Headache  disappears  with  the  de- 
lirium. 
No  muscular  rigidity. 
Mulberry  rash. 
No  strabismus. 
No  convulsions  or  paralysis. 


7.  Countenance  blank. 


7.   Throat  red  and  injected. 

Cerebro-spinal  Meningitis. 

1.  Occipital  headache. 

2.  Pain   in  head   continues  v/ith  the 

delirium. 

3.  Muscular  rigidity  appears  early. 

4.  Herpetic  eruption,  if  any. 

5.  Strabismus. 

6.  Convulsions     and    paralysis    com- 

mon. 

7.  Face  pinched  and  anxious. 


ACUTE  GENERAL  DISEASES. 


113 


NAME   OF    DISEASE. 

Typhus  Fever. 

8.  Temperature  remains  high   from 

first. 

9.  Pulse  rapid  and  compressible, 

10.  No  vomiting. 

11.  Crisis. 

Yellow  Fever. 


DISEASES   TO    BE   DIFFERENTIATED. 

Cerebro-spinal  Meningitis. 

8.   Temperature  rises  slowly  seldom 

over  104°. 
g.   Pulse  slow. 

10.  Frequent  vomiting. 

11.  No  critical  days. 

Acute   Yellov7  Atrophy  of  Liver. 


See  Acute  Yellozv  Atrophy  of  Liver,  page  81. 


Yellow  Fever. 

1.  Temperature  rarely  over  104°. 

2.  Pulse  comparatively  slow  and  gas- 

eous. 

3.  Jaundice  well-marked. 

4.  Supra-orbital  pain. 

5.  Remission  about  the  fourth  day. 

6.  Spleen  not  greatly  enlarged. 

7.  Fiery  eye. 

8.  Hemorrhages  common. 

Yellow  Fever. 

1.  Temperature  constant  until  remis- 

sion. 

2.  Constipation. 

3.  Supra-orbital  pain. 

4.  Countenance  peculiar. 

5.  Jaundice  well-marked. 

6.  Hemorrhages  common. 

7.  Urine  albuminous. 

8.  Spleen  slightly  enlarged. 

9.  Disease  of  short  duration. 

Yellow^  Fever. 

1.  Temperature  rarely  over  104. 

2.  Pulse  slow  and  gaseous. 


Relapsing  Fever. 

1.  Temperature  105°  to  107°. 

2.  Pulse  very  rapid. 

3.  Jaundice  slight  and  late  in  appear- 

ing. 

4.  Arthritic  and  muscular  pain. 

5.  Intermission  end  of  first  week. 

6.  Spleen  much  enlarged. 

7.  No  change  in  face. 

8.  Hemorrhages  uncommon. 

Typho-malarial  Fever. 

1.  Periodicity  in  daily  temperature. 

2.  Diarrhoea. 

3.  Pain  in  iliac  fossa. 

4.  No  peculiar  countenance. 

5.  Slight  jaundice. 

6.  Hemorrhages  uncommon. 

7.  Urine  normal. 

8.  Spleen  greatly  enlarged. 

9.  Disease  of  long  duration. 

Pernicious  Malarial  Fever. 

1.  Temperature  104  to  106. 

2.  Pulse  rapid. 


114 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF    DISEASE. 

Yellow  Fever. 

3.  Remission  about  the  fourth  day. 

4.  Hemorrhages  common. 

5.  Tongue  clean. 

6.  Mind  clear. 

7.  Fiery  eye. 

8.  Supra-orbital  pain. 

9.  Urine  albuminous. 

10.   Vomiting  projectile  and  severe. 

Relapsing  Fever. 

See  Typhus 

Relapsing  Fever. 

See  Yellow 

Relapsing  Fever. 

1.  Continued  high  temperature  until 

remission. 

2.  Pulse  very  rapid. 

3.  Intense  arthritic  pains. 

4.  Complete  relapse. 

5.  Sweating      without    reduction     of 

temperature. 

6.  Crisis. 

7.  Blood  contains  spirilli. 


DISEASES   TO    BE   DIFFERENTIATED. 

Pernicious  Malarial  Fever. 

3.  Remission     within-    twenty-four 
hours. 

4.  Hemorrhages  rare. 

5.  Tongue  coated. 

6.  Delirium  or  stupor. 

7.  Countenance  not  peculiar. 

8.  No  supra-orbital  pain. 

9.  No  albumen  in  urine. 
10.  Vomiting  retching  and  moderate. 

Typhus  Fever. 

Fever,  page  iii. 

Yellow  Fever, 

Fever,  page  113. 

Remittent  Fever. 

1.  Daily  remissions. 

2.  Pulse  not  very  rapid. 

3.  No    severe    pain    in    muscles    or 
joints. 

4.  No  relapses. 

5.  Sweating   with  reduction  of  tem-, 
perature. 

6.  No  crisis. 

7.  Blood  contains  free  pigment. 


Relapsing  Fever. 

1.  Begins  with  a  chill  and  high  fever. 

2.  No  swelling  of  joints. 

3.  No  enlarged  glands. 

4.  Complete  intermission  toward  the 

end  of  first  week. 


Dengue  Fever. 

1.  Begins  as  a  rheumatism. 

2.  Joints  swollen  and  tender. 

3.  Glands  enlarged  and  tender. 

4.  Remission  on  third  or  fourth  day. 


ACUTE  GENERAL  DISEASES. 


115 


NAME   OF   DISEASE. 

Relapsing  Fever. 


5.  Vomiting. 

6.  Profuse  sweats. 

7.  No  eruption. 


Intermittent  Fever. 

1.  History    of   exposure    to  malarial 

poisoning. 

2.  Paroxysms  regular. 

3.  Temperature  very  high. 

4.  Jaundice  uncommon. 

5.  No  severe  prostration. 

6.  Breath  normal  odor. 

7.  No  pidmonary  or  joint  symptoms. 

8.  No  points  of  local  infection. 

Intermittent  Fever. 

1.  Many  chills. 

2.  Complete  intermissions. 

3.  Periods  of  no  fever. 

4.  Regular    development    of    parox- 

ysms. 

5.  Patient  feels  well  during  the  inter- 

missions. 


DISEASES   TO    BE    DIFFERENTIATED. 

Dengue  Fever. 

5.  Vomiting  uncommon. 

6.  No  profuse  sweats. 

7.  Accompanpng     the      relapse      an 

eruption    appears    first    on     the 
hands. 

Pyaemia. 

1.  History  of  injury  or  infectious  dis- 

ease. 

2.  Irregular  paroxysms. 

3.  Temperature  lower. 

4.  Jaundice.  « 

5.  Patient  greatly  prostrated. 

6.  Breath  sweet  and  nauseous, 

7.  Abscess  of  lungs  and  joints. 

8.  Points  of  local  infection. 

Remittent  Fever. 

1.  One  Chill. 

2.  Remissions. 

3.  Always  fever. 

4.  Symptoms  irregularly  developed. 

5.-  Patient  feels  sick  all  of  the  time. 


Remittent  Fever.  Typhoid  Fever. 

See  Typhoid  Fever,  page  no.  ^ 

Remittent  Fever.  Yellow  Fever. 

See  Yellow  Fever,  page  113. 

Remittent  Fever.  Relapsing  Fever. 

See  Relapsing  Fever,  page  114. 


ii6 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF   DISEASE.  DISEASES    TO    BE   DIFFERENTIATED. 

Remittent  Fever.  Intermittent  Fever. 

See  Intermittent  Fever,  page  115. 


Pernicious  Malarial  Fever. 

(Cerebral  form.) 

1.  Coma  appears  early. 

2.  History  of  malaria. 


7. 


Temperature  very  high. 

Pulse  rapid  and  full. 

Distinctly  paroxysmal. 

Attack  ends  in  a  few  hours  with 

sweating,     fall    in     temperature, 

and  sleep. 
Free  pigment  in  blood. 


Pernicious  Malarial  Fever. 

(Gastro-enteric  form.) 

1.  History  of  malarial  infection. 

2.  Temperature  elevated. 

3.  Discharges  bloody  from  first. 

4.  No  albumen  in  urine. 

5.  Vomiting  painful  and  retching. 

6.  Free  pigment  in  blood. 


Cerebro-Spinal  Meningitis. 

1.  Coma  preceded  by  headache,  de- 

lirium, etc. 

2.  History    of   injury   and   infectious 

disease. 

3.  Temperature  rarely  over  104°. 

4.  Pulse  slow  and  irregular. 

5.  No  intermissions  or  remissions, 

6.  Attacks  usually  end  in  coma  and 

death. 

7.  No  pigment  in  blood. 

Cholera. 

1.  History  of  epidemic  cholera. 

2.  Temperature  subnormal. 

3.  Rice-water  evacuations. 

4.  Urine  albuminous. 

5.  Vomiting  regurgitative. 

6.  Comma  bacilli  in  discharges. 


Pernicious  Malarial  Fever.  Yellow  Fever. 

■  (Bilious  remittent  fever.) 

See    Yellow  Fever,  page  113. 

Small-Pox.  ^  Scarlet  Fever. 

Begins  with  a  chill  and  severe  pain  I.  Begins  with  headache,  vomiting, 
in  head  and  back.  sore  throat,  and  chilliness. 

Eruption  appears  on  third  day  2.  Eruption  appears  beginning  of 
around  the  edges  of  the  hair.  second  day  about   the  neck  and 

chest. 


ACUTE  GENERAL  DISEASES. 


117 


NAME    OF    DISEASE. 

Small-Pox. 

3.  Eruption  changes  from  day  to  day 

— macular,     papular,      vesicular, 
and  lastly,  pustular. 

4.  Eruption  spreads  slowly. 

5.  Remission  on  occurrence  of  erup- 

tion. 

6.  Relapse  or  secondary  fever  about 

tlie  eighth  day. 

7.  Scabbing  and  pitting. 

Small-Pox. 

1.  Begins  with  a  chill  and  a  severe 

pain  in  head  and  back. 

2.  Eruption    appears    about  the    hair 

on  third  day. 

3.  Eruption    macular,    then   papular, 

vesicular,  and  lastly  pustular. 

4.  Remission  on  occurrence  of  erup- 

tion. 

5.  Secondary  fever  and  relapse  during 

suppuration. 

6.  Scabbing  and  pitting. 

Small-Pox. 

1.  Pustules  rnaturate  on  eighth  day. 

2.  vSecondary  fever. 

3.  Deep  suppuration. 

4.  Many  pustules. 

5.  Pustules  burst,  then  dry,   forming 

scabs. 

6.  Cicatrices  well  marked. 

Small-Pox. 

1.  Begins  with  high  temperature,  etc. 

2.  Vesicles  terminate  in  pustules. 


DISEASES    TO    BE    DIFFERENTIATED. 

Scarlet  Fever. 

3.  Eruption  erythematous  with  inter- 

spersed,   minute,    elevated,    dark 
red  points. 

4.  Eruption  spreads  rapidly. 

5.  No  remission  in  symptoms. 

6.  No  secondary  fever. 

7.  Well-marked  scaly  desquamation. 

Measles. 

1.  Begins   with   the    symptoms    of    a 

severe  cold. 

2.  Eruption  appears  on  the  face    on 

the  fourth  day. 

3.  Eruption   papular,   and  appears  in 

crescentic  patches. 

4.  Temperature  rises  on    appearance 

of  eruption. 

5.  No  secondary  fever. 

6.  Bran-like  desquamation. 

Varioloid. 

1.  Pustules   maturate  from  fourth  to 

sixth  day. 

2.  No  secondary  fever. 

3.  Superficial  suppuration. 

4.  Few  pustules. 

5.  Pustules  dry  up  without  bursting. 

6.  Cicatrices  not  well  marked. 

Chicken-Pox. 

1.  Fever,  etc.,  follow  the  eruption. 

2.  Vesicles  dry  up  without  pustulating. 


ii8 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF   DISEASE. 

Small-Pox. 

3.  Eruption  complete  on  eighth  day. 

4.  Eruption  begins  about  the  hair. 

5.  Vesicles  umbilicated. 

6.  Remission  on  occurrence  of  erup- 

tion. 

7.  Secondary  fever. 


DISEASES   TO    BE   DIFFERENTIATED. 

Chicken-Pox. 

3.  Eruption  complete  on  fourth  day. 

4.  Eruption  begins  on  the  trunk. 

5.  Vesicles  globular. 

6.  No  remissions.  * 

7.  No  secondary  fever. 


Small-Pox. 

Cerebro-Spinal  Meningitis. 

I. 

Frontal  headache. 

I. 

Occipital  headache. 

2. 

Face  flushed. 

2. 

Face  pale  and  anxious. 

3- 
4- 

5- 

Temperature  high. 
Pulse  rapid. 
Sore  throat. 

3. 

4- 

5. 

Temperature  rarely  over  104*. 
Pulse  not  very  rapid. 
No  sore  throat. 

6. 

7. 

Vomiting  retching. 
Temperature  falls  with  the  appear- 
ance of  the  eruption. 
Etc,  etc.,  etc. 

6. 

7. 

Vomiting  projectile. 
No  fall  in  temperature  on  appear- 
ance of  eruption. 

Etc.,  etc.,  etc. 

Small-Pox. 

1.  No  great  muscular  prostration. 

2.  Sore  throat. 

3.  Eruption  appears  on  third  day. 

4.  Eruption  appears  first  about  hair. 

5.  Characteristic    eruption    of   small- 

pox. 

Etc.,  etc.,  etc. 

Scarlet  Fever. 

1.  Begins  with  chilliness,  vomiting, 

headache,  and  sore  throat. 

2.  Eruption  appears  on    the  second 

day. 

3.  Eruption  erythematous  with 
minute,  interspersed,  elevated 
dark  red  spots. 


Typhus  Fever. 

1.  Severe  muscular  prostration. 

2.  No  sore  throat. 

3.  Eruption  appears  on  fifth  day. 

4.  Eruption  appears  first  on  trunk. 

5.  Characteristic  typhus  eruption. 

Etc.,  etc.,  etc. 

Measles. 

1.  Begins   as  a    severe    cold  in   the 

head. 

2.  Eruption  appears  on    the  fourth 

day. 

3.  Eruption  papular,  and  is  arranged 

in  crescentic  patches. 


ACUTE  GENERAL  DISEASES. 


119 


NAME   OF   DISEASE. 

Scarlet  Fever. 

4.  Strawberry  tongue.- 

5.  Severe  sore  throat. 

6.  Albumen  in  urine. 

7.  Eruption,  appears   first    on    nedc 

and  chest. 

8.  Eruption  spreads  rapidly. 

9.  Desquamation  scale-like. 
10.   Sequelae  Bright's  disease. 

Scarlet  Fever. 

1.  Diffuse    redness     of     tonsils    and 

pharynx. 

2.  Exudation  mucous  and  easily  re- 

moved. 

3.  Strawberry  tongue. 

4.  Temperature  very  high. 

5.  Erythematous     eruption    followed 

by  desquamation. 

6.  Sequelae,  Bright's  disease. 


DISEASES   TO   BE   DIFFERENTIATED. 

Measles. 

4.  Tongue  coated. 

5.  Bronchitis. 

6.  Urine  normal. 

7.  Eruption  appears  first  on  face. 

8.  Eruption  spreads  slowly. 

9.  Desquamation  bran-like. 

10.  Sequelae  broncho-pneumonia. 

Diphtheria. 

1.  Dark  local  redness  of  throat. 

2.  Exudation   membranous    and    ad- 

herent. 

3.  Tongue  dry  and  cracked. 

4.  Temperature  rarely  over  104.° 

5.  No  eruption,  if    any,  roseola  not 

followed  by  desquamation. 

6.  Sequelae,  paralysis. 


Scarlet  Fever. 


Small-Pox. 


See  Small-Pox,  page  116. 


Scarlet  Fever. 

High  temperature. 

Eruption  covers  the  body. 

Sore  throat. 

Enlarged  cervical  glands. 

Urine  albuminous. 

Strawberry  tongue. 

Eruption  interspersed  with  minute 

dark  red,  elevated  spots. 
Desquamation. 

Measles. 


Erythema  (Simple). 

1.  Temperature  slightly  elevated. 

2.  Eruption  irregularly  distributed. 

3.  No  sore  throat. 

4.  Glands  not  enlarged. 

5.  No  albumen  in  urine. 

6.  Tongue  normal. 

7.  Eruption  uniform. 

8.  No  desquamation. 

Typhus  Fever. 


See  Typhus  Fever,  page  112. 


120 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Measles. 

1.  Eruption  confluent, 

2.  Coryza  and  bronchitis  well  marked. 

3.  Temperature  high. 

4.  Eruption  dark,  elevated  and  cres- 

centic. 

5.  Eruption  appears  first  on  the  face. 

6.  No  sore  throat. 

7.  Desquamation. 

Measles. 


DISEASES   TO    BE    DIFFERENTIATED. 

Roseola. 

1.  Non-confluent  eruption. 

2.  Slight  coryza  and  bronchitis. 

3.  Temperature  slightly  elevated. 

4.  Eruption  bright,   smooth,  and  not 

crescentic. 

5.  Eruption  appears  first  on  trunk. 

6.  Some  sore  throat. 

7.  No  desquamation. 

Scarlet  Fever. 


See  Scarlet  Fever  J  page  118. 

Measles.  Small-Pox. 

See  Small-Pox,  page  117. 


Cholera. 

1.  Mouth  and  pharynx  normal. 

2.  Vomiting   painless  and   regurgita- 

tive. 

3.  No  burning  pain  in  oesophagus  or 

stomach. 

4.  Rice-water  discharges. 

5.  Comma  bacilli  in  discharges. 

Cholera. 


Acute  Poisoning. 

1.  Mouth   and    pharynx    glazed   and 

congested. 

2.  Vomiting  painful  and  retching. 

3.  Intense  burning  sensation  in  stom- 

ach and  oesophagus. 

4.  Discharge  bloody  and  mucous. 

5.  Poison  found  in  discharges. 


Cholera  Morbus. 

See  Cholera  Morbus,  page  59. 

Cholera.  Pernicious  Malarial  Fever. 

See  Pernicious  Malarial  Fever,  page  116. 

Diphtheria.  Membranous  Croup. 

1.  Preceded  by  sore  throat.  i.   Preceded  by  cough  and  hoarseness. 

2.  Attacks  any  one.  .  2.  Attacks  children. 

3.  Cervical  glands  greatly  enlarged.  3.   Glands  but  slightly  enlarged. 


ACUTE  GENERAL  DISEASES. 


121 


NAME   OF   DISEASE. 

Diphtheria. 

4.  Great  prostration  from  the  first. 

5.  Exudation  deep — cannot  be  readi- 

ly detached. 

6.  Exudation  if  detached  leaves  an 

ulcer. 

7.  Temperature  rarely  over  104°. 

8.  Exudation   of    a  gray-color,    and 

contains  characteristic  bacteria. 


DISEASES   TO   BE   DIFFERENTIATED. 


9- 
10. 


9.   Death  due  to  blood-poison. 
10.   Sequelae,  paralysis. 

Diphtheria. 

See  Scarlet  Fever, 

Diphtheria. 

1.  Begins  with  sore  throat  and  slight 

fever. 

2.  Constitutional      symptoms      well- 

marked. 

3.  Inflammation  localized  at  first. 

4.  Pulse  feeble  and  rapid. 

5.  Cervical  glands  greatly  enlarged. 

6.  Exudation    cannot    be    easily   re- 

moved. 

7.  Laryngeal  symptoms  common.  7. 

Diphtheria. 

1.  Tongue  coated.  i. 

2.  Throat  not  greatly  sv/ollen.  2. 

3.  Cervical  glands  greatly  enlarged.  3. 

4.  Exudation  membranous.  4. 

5.  Throat  has  a  grayish  appearance.  5. 


I. 


Membranous  Croup. 

Prostration  follows  the  throat-ob- 
struction. 

Exudation  superficial  —  can  be 
readily  detached. 

No  ulcer  produced  by  detaching 
the  exudation. 

Temperature  often  104°  to  106°. 

Exudation  of  a  white  color,  and 
does  not  contain  characteristic 
bacteria. 

Death  usually  due  to  suffocation. 

No  paralysis. 

Scarlet  Fever. 
page  119. 

Diphtheritic  Sore  Throat. 

Begins  with  a  chill  and  high  range 
of  temperature. 

No  severe  depression  or  prostra- 
tion. 

General  inflammation  of  throat. 

Pulse  rapid  and  strong. 

Glands  slightly  enlarged. 

Exudation  easily  removed  or 
picked   off. 

Usually  no  complicating  laryn- 
gitis. 

Erysipelas  of  Throat. 

Tongue  brown  and  fissured. 
Throat  greatly  swollen. 
Cervical  glands  slightly  enlarged. 
Exudation  serous  in  character. 
Mucous  membrane  of  throat  vivid 
or  dusky  in  color, 


122 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE.       - 

Epidemic  Cerebro-Spinal  Menin- 
I  gitis. 

1.  History  of  epidemic. 

2.  Muscular  rigidity  appears  early. 

3.  Pain  and  tenderness  along  spine. 

4.  No  peculiar  cry. 

5.  Delirium  often  wild. 

6.  Disease  begins  suddenly. 

7.  Herpetic  eruption  common. 

8.  Pulse  moderately  slow. 
q.  Incoordinate  movements. 


DISEASES   TO    BE   DIFFERENTIATED. 

Tubercular  Meningitis. 

1.  History  of  tuberculosis. 

2.  Muscular  rigidity  appears  late. 

3.  No  marked  spinal  symptoms. 

4.  Hydrocephalic  cry. 

5.  Mild  delirium. 

6.  Disease  develops  slowly. 

7.  No  herpetic  eruption. 

8.  Pulse  very  slow  at  first. 

9.  Automatic  movements, 

Small-Pox. 


Epidemic  Cerebro-Spinal   Menin- 
gitis. 

See  Small-Pox,  page  118. 

Epidemic  Cerebro-Spinal   Menin-  Typhus  Fever, 

gitis. 

See  Typhus  Fever,  page  112. 

Epidemic  Cerebro-Spinal   Menin- 
gitis. Pernicious  Fever. 

See  Pernicious  Fever ^  page  116. 

Pyaemia.  Septicaemia. 

1.  Begins  with  a  chill.  i.  Begins  with  chilly  sensations. 

2.  Recurrent  chills,  fever,  and  sweat-       2.   No  recurrent  chills  and  sweating. 

ing. 

3.  Jaundice  well  marked.  3.  Slight  jaundice. 

4.  Sweetish  odor  to  breath.  4.  Odor  to  breath  not  peculiar. 

5.  Temperature     irregular — 100°  to       5.  Temperature  less  fluctuating. 

105°. 

6.  Diarrhoea  moderate  if  present.  6.  Obstinate  diarrhoea. 

7.  Formation  of  metastatic  abscesses       7.  No  metastatic  abscesses. 

in  lungs,  joints,  etc. 


ACUTE  GENERAL  DISEASES. 


123 


NAME   OF   DISEASE.  DISEASES   TO    BE   DIFFERENTIATED. 

Pyaemia.  Intermittent  Fever. 

See  Intermiiieni  Fever,  page  115. 

Pyaemia.  Acute  Yellow  Atrophy. 

See  Acute  Yellow  Atrophy,  page  81. 

Pyaemia.  Ulcerative  Endocarditis. 

See  Ulerative  Endocarditis,  page  40. 

Pyaemia.  Suppurative  Nephritis. 

See  Suppurative  Nephritis,  page  98. 

Tetanus. 


Hydrophobia. 

1.  History  of  dog  or  cat  bite. 

2.  Delirium. 

3.  Fear  of  liquids. 

4.  Clonic  convulsions. 

5.  Marked  hyperaesthesia. 

6.  Special  senses  involved. 

7.  Much  frothy  mucus  about  mouth. 

8.  Spasms  occur  at  intervals. 

Hydrophobia. 

1.  History  of  dog  or  cat  bite. 

2.  Spasms  clonic. 
5.  Delirium. 

4.  Special  senses  affected. 

5.  Fear  of  liquids,  caused  by  (he  ina- 

bility to  swallow  without  produc- 
ing convulsions. 

6.  Occurs  usually  in  men. 

7.  Moral  treatment  has  no  effect. 


1.  History  of  injury. 

2.  Mind  clear. 

3.  No  fear  of  liquids. 

4.  Convulsions  tonic. 

5.  Slight  hyperaesthesia. 

6.  Special  senses  normal. 

7.  Risus  sardonicus. 

8.  Severe  tonic  spasms  all  the  time. 

Hysteria. 

1.  Hysterical  history. 

2.  Spasms  hysterical. 

3.  Mind  clear. 

4.  Special  senses  normal. 

5.  Fear  of   liquids  imaginary,  as  pa- 

tient can  swallow  without  caus- 
ing spasms. 

6.  Occurs  usually  in  hysterical  young 

women. 

7.  Moral  treatment  curative. 


DIFFERENTIAL  DIAGNOSIS  OF  THE  CHRONIC  GEN- 
ERAL DISEASES. 


DIFFERENTIAL  DIAGNOSIS  OF  THE  CHRONIC  GEN- 
ERAL DISEASES. 


NAME  OF  DISEASE. 
Acute  articular  rheumatism 

Arthritis  deformans  . 


Diabetes 


Pernicious  anaemia 

Ansemia     . 
Leucocythsemia 


Scurvy 
Trichinosis 

Alcoholism 


DISEASES  TO  BE  DIFFERENTIATED. 

Acute  gout. 
Gonorrhoeal  rheumatism. 

Chronic  articular  rheumatism. 
Chronic  gout. 

Glycosuria. 

Simple  anaemia. 

Chlorosis. 

Leucoc3rthaemia. 

Chlorosis. 
Pernicious  anaemia. 

Pseudo-leukaemia. 
Pernicious  anaemia. 

Purpura. 

Myalgia. 
Typhoid  fever. 

Apoplexy. 

Uraemia. 
-    Meningitis. 

Opium  poisoning. 
^  Sunstroke. 
127 


128 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE. 

Myalgia     * 

Syphilis  (chancre)       .         .         .         . 

Acute  Articular  Rheumatism. 

1 .  History  of  exposure  to  wet  or  cold. 

2.  Begins  with  a  chill  and  fever. 


3.  Large  joints  first  attacked. 

4.  Pain  constant. 

5.  Temperature  high. 

6.  Profuse  sweats. 

7.  Attacks  young  people  usually. 

8.  Joint  swollen,  but  not  greatly  in- 

flamed. 

9.  No  pruritis  or  desquamation. 

10.  Urine  abundant. 

11.  Frequent  cardiac  complications. 

12.  Tophi  never  formed. 

Acute  Articular  Rheumatism. 

1.  History  of  exposure  to  cold,  etc. 

2.  Begins  usually  with  a  chill. 

3.  Many  joints  attacked. 

4.  Eyes  rarely  inflamed, 

5.  Copious  sweating. 

6.  Temperature  high. 

7.  Disappears    rapidly    under    treat- 

ment. 


DISEASES   TO   BE  DIFFERENTIATED. 

'  Neuralgia. 
Intestinal  colic. 

Trichinosis.  ' 

Spinal  meningitis. 

Chancroid. 

Acute  Gout. 

1.  History  of  high  living  or  heredi- 

tary tendency. 

2.  Begins  at  night  with  severe  pain 

in  some  small  joint — as  the  great 
toe 

3.  Small  joints  first  attacked. 

4.  Pain  paroxysmal. 

5.  Temperature  rarely  over  103°. 

6.  No  profuse  sweats. 

7.  Attacks  adults. 

8.  Joints  greatly  inflamed  with  sur-  : 

rounding  veins  enlarged. 

9.  Desquamation  and  itching  of  skin 

about  joint  attacked. 

10.  Urine  scanty  and  highly  colored. 

11.  No  cardiac  complications. 

12.  Frequent  formation  of  tophi, 

Gonorrhoeal  Rheumatism. 

1.  History  of  gonorrhoea. 

2.  Begins  with  pain  and  lameness  in 

one  joint,  usually  the  knee. 

3.  Usually  but  one  or  two  joints  at- 

tacked. 

4.  Eyes  frequently  inflamed. 

5.  No  profuse  sweats. 

6.  Temperature  rarely  over  102°. 

7.  Treatment  has  but  little  effect. 


CHRONIC  GENERAL  DISEASES. 


129 


NAME   OF   DISEASE. 

Acute  Articular  Rheumatism. 

8.  Frequent  cardiac  complications. 

9.  Pain  very  severe  and  acute. 

Arthritis  Deformans. 

1.  Not  hereditary. 

2.  Disease  progressive. 

3.  Usually  attacks  females. 

4.  No  kidney  complications. 

5.  No  chalky  deposits. 

6.  Marked  deformity  and  ankylosis. 

7.  No  excess  of  uric  acid. 

Arthritis  Deformans. 

1.  No  history  of  acute  rheumatism. 

2.  Disease  progressive. 

3.  Marked  deformity. 

4.  Small  joints  first  involved. 

5.  Weather  has   no    effect  upon   the 

.  disease. 

Diabetes. 

1.  Occurs  at  all  ages. 

2.  Causes  unknown. 

3.  Amount  of  sugar  varies  but  little 

from  day  to  day. 

4.  Polyuria     and     polyphagia     well- 

marked. 

5.  Well-marked    nervous    and    skin 

symptoms. 

6.  Fehling's  method  of  analysis  easy. 

7.  Complications,    as    phthisis,    etc., 

common. 


DISEASES  TO    BE   DIFFERENTIATED. 

Gonorrhceal  Rheumatism. 

8.  Heart  rarely  attacked. 

9.  Subacute  inflammation  of  joint. 

Chronic  Gout. 

1.  Hereditary. 

2.  Disease  periodic. 

3.  Usually  attacks  males. 

4.  Frequent  kidney  complications. 

5.  Chalky  deposits  in  joints,  etc. 

6.  Marked    deformity  and    ankylosis 

uncommon. 

7.  Excess  of  uric  acid. 

Chronic  Rheumatism. 

1.  History  of  acute  rheumatism. 

2.  Disease  periodical. 

3.  Deformity  not  well-marked. 

4.  Large  joints  first  attacked. 

5.  Disease     worse     in     damp,     cold 

weather. 

Simple  Glycosuria. 

1.  Common  in  aged  people. 

2.  Caused  by  insanity,  injuries,  medi- 

cine, etc. 

3.  Amount    of    sugar   varies    greatly 

from  time  to  time. 

4.  Polyuria      and      polyphagia      less 

severe. 

5.  Obscure   nervous   and   skin   symp- 

toms. 

6.  Method  of    analysis  obscure  from 

presence  of  keratinine. 

7.  Complications  rare. 


130 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF  DISEASE. 

Pernicious  Ansmia. 

1.  Disease  of  adults. 

2.  Dropsy. 

3.  Hemorrhages  common. 

4.  Purpura. 

5.  Fever. 

6.  Face  has  a  straw  color. 

Pernicious  Anaemia. 

1.  No  severe  emaciation. 

2.  Fever. 

3.  Hemorrhages  common. 

4.  Purpuric  spots. 

5.  Persistent  dropsy  and  cardiac  mur- 

murs. 

6.  Severe  dyspnoea. 

7.  Does  not  yield  to  treatment. 

Pernicious  Anaemia. 

1.  Spleen  normal. 

2.  Glands  not  enlarged. 

3.  Bones  not  painful  or  tender. 

4.  No  pain  in  sternum. 

5.  Hemorrhages  occur  early. 

6.  Fever. 

7.  No  actual  increase  in  the  number 

of  white  blood  corpuscles. 

Simple  Anaemia. 

1.  Emaciation. 

2.  Skin  pale. 

3.  Attacks  any  one 

4.  No  mental  disturbance. 

5.  No  uterine  complications. 

6.  No  cough  or  severe  dyspnoea. 


DISEASES  TO   BE  DIFFERENTIATED. 

Chlorosis. 

1.  Disease  of  girls  at  puberty. 

2.  No  dropsy. 

3.  Hemorrhages  uncommon* 

4.  No  purpuric  eruption. 

5.  No  fever. 

6.  Face  has  a  greenish  hue. 

Anaemia. 

1.  Quite  rapid  emaciation. 

2.  No  fever. 

3.  Occasional  hemorrhages. 

4.  No  purpuric  eruptions. 

5.  Occasional  slight  dropsy  and  blow- 

ing murmurs. 

6.  Slight  dyspnoea. 

7.  Yields  readily  to  treatment. 

Leucocythaemia. 

1.  Spleen  greatly  enlarged. 

2.  Lymphatic  glands  enlarged. 

3.  Bones  painful  and  tender. 

4.  Pain  in  sternum. 

5.  Hemorrhages  occur  late. 

6.  No  fever. 

7.  White  blood  corpuscles  greatly  in- 

creased, often  one  in  twenty. 

Chlorosis. 

1.  No  emaciation. 

2.  Skin  has  a  greenish  hue. 

3.  Disease  of  girls  at  puberty. 

4.  Mental  disturbance. 

5.  Frequent  uterine  complications. 

6.  Severe  cough  and  dyspnoea. 


CHRONIC  GENERAL  DISEASES. 


131 


NAME  OF  DISEASE. 

Leucocythsmia. 

1.  Spleen  greatly  enlarged. 

2.  Lymphatic   glands    somewhat  en- 

larged. 

3.  Pain  in  bones,  especially  sternum, 

well  marked. 

4.  White  blood  corpuscles  greatly  in- 

creased (i  to  20). 

5.  Progressive  ansemia  and  rapid  loss 

of  health. 


DISEASES   TO   BE  DIFFERENTIATED. 

Pseudo-Leukaemia. 

1.  Spleen  somewhat  enlarged. 

2.  Lymphatic  glands  greatly  enlarged. 

3.  Pain  in  bones  less  marked. 

4.  Number  of  white  blood  corpuscles 

not  actually  increased. 

5.  Ansemia   and   loss   of    health   less 

marked. 


Leucocythaemia.  Pernicious  Anaemia. 

See  Pernicions  Anczmia,  page  130. 


Scurvy. 

I.  Hemorrhages  not  confined  to  free 
surfaces. 
Disease  of  long  duration. 
History  of  faulty  nutrition. 
CEdema  well  marked. 
Muscles  swollen. 

Great  depression  and  despondency. 
Gums  spongy. 

8.  Attacks  numbers  of  .people. 

9.  Treatment  dietetic. 

Trichinosis. 

1.  Abdominal  pain. 

2.  Fever. 

3.  Diarrhoea. 

4.  History  of  eating  raw  meat, 

5.  Trichinae  found  in  muscle. 

6.  CEdema  of  eyelids,  feet,  etc. 


Purpura. 

1.  Hemorrhages  confined  to  free  sur- 

faces. 

2.  Disease  of  short  duration. 

3.  No  faulty  dietetic  history. 

4.  No  oedema. 

5.  No  swelling  of  muscles. 

6.  No  mental  prostration. 

7.  Gums  normal. 

8.  Seen  in  isolated  cases. 

9.  Dietetic  treatment  of  no  effect 

Myalgia. 

1.  No  deep  abdominal  pain. 

2.  No  fever. 

3.  No  diarrhoea. 

4.  History   of    exposure    to    wet    or 

strain. 

5.  Examination  of  muscle  negative. 

6.  No  oedema. 


132 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME  OF  DISEASE. 

Trichinosis. 


DISEASES   TO   BE   DIFFERENTIATED. 

Typhoid  Fever. 


See  Typhoid  Fever ^  page  iii. 


Alcoholism  (Coma). 

1.  Patient  can  be  aroused. 

2.  Pupils  equal. 

3.  Pupils  dilate  by  slapping  face. 

4.  Reflexes  normal. 

5.  Odor  of  alcohol  about  patient. 

6.  Steamboat  respiration. 

7.  No  paralysis  or  convulsions. 

8.  Pulse  rapid. 

9.  Temperature  equal  on  both  sides. 

Alcoholism  (Delirium). 

1.  Delirium  wild  but  coherent. 

2.  Temperature  normal. 

3.  Surface  cool  and  sweaty. 

4.  Pupils  normal. 

5.  Patient  sees  animals  and  objects. 

6.  Does  not  complain  of  pain. 

7.  Pulse  rapid. 

8.  Marked  tremor. 

g.  Eyes  wild  but  otherwise  no  pecul- 
iar appearance  of  body. 

Alcoholism  (Coma). 

1.  Pupils  about  normal. 

2.  Pupils  dilate  by  slapping  face. 

3.  Surface  hot  and  often  congested. 

4.  Respiration  hurried  and  deep. 

5.  Respirations  regular  and  blowing 

in  character. 


Apoplexy. 

1.  Cannot  arouse  patient. 

2.  Pupils  unequal. 

3.  Pupils  do  not  respond. 

4.  Reflexes  often  absent  on  one  side. 

5.  No  peculiar  odor  about  patient. 

6.  Stertorous  respiration. 

7.  Paralysis  and  convulsions  common. 

8.  Pulse  slow. 

9.  Temperature  elevated  on  paralyzed 

side. 

Acute  Meningitis. 

1.  DeUrium  incoherent  and  not  very 

wild. 

2.  Temperature  elevated. 

3.  Surface  hot  and  dry. 

4.  Pupils  contracted. 

5.  Patient  continually  trying  to   get 

out  of  bed. 

6.  Patient  complains  of  headache. 

7.  Pulse  slow. 

8.  No  tremor. 

9.  "Boat-belly"  and  strabismus,  or 

photophobia  common. 

Opium  Poisoning. 

1.  Pupils  "pin -head." 

2.  Pupils  do  not  respond. 

3.  Surface  cool  and  perspiring. 

4.  Respiration  very  slow. 

5.  Respirations  irregular  and  shallow 

in  character. 


CHRONIC  GENERAL  DISEASES. 


133 


NAME   OF   DISEASE. 

Alcoholism  (Coma). 

6.  Smell  of  alcohol  about  patient. 

7.  Pulse  rapid. 

8.  Face  flushed. 

Alcoholism. 

1.  Temperature  normal. 

2.  No  diarrhoea. 

3.  Odor  of  alcohol  about  patient. 

4.  Reflexes  normal. 

5.  Steamboat  respiration. 

6.  Patient  can  swallow. 


DISEASES   TO    BE   DIFFERENTIATED. 

Opium  Poisoning. 

6.  Odor  of  opium  about  patient. 

7.  Slow  pulse. 

8.  Face  pale  and  cyanotic. 

Sun-Stroke. 

1.  Temperature  very  high. 

2.  Profuse  diarrhoea. 

3.  No  peculiar  smell  about  patient. 

4.  Reflexes  absent. 

5.  Quiet  or  stertorous  breathing. 

6.  Patient  cannot  swallow. 


Alcoholism  (Coma). 

See   UrcBinia,  pa: 


ge92. 


Syphilis  (Chancre). 

1.  Incubation  about  twenty  days. 

2.  Begins  as  a  papule. 

3.  Single. 

4.  Ulceration  superficial. 

5.  Edges  of  ulcer  sloping. 

6.  Floor  of  ulcer  copper-colored. 

7.  Scanty  secretion. 

8.  No  pain. 

9.  Indolent  induration  of  glands. 

10.  Constitutional  symptoms. 

Myalgia. 

1.  Skin  normal. 

2.  Skin  not  sensitive  to  pressure. 

3.  Pain  greatly  increased  by  contrac- 

tion of  muscle. 


Uraemia. 


Chancroid. 


Incubation  from  one  to  five  days. 

Begins  as  a  pustule  or  ulcer. 

Multiple. 

Deep  ulceration. 

Edges  of  ulcer  abrupt. 

Floor  of  ulcer  worm-eaten  in  ap- 
pearance. 

Secretion  purulent  and  abundant. 

Ulcer  painful. 

Acute  suppurative  inflammation 
of  glands. 

Disease  purely  local. 

Neuralgia. 

1.  Skin  frequently  inflamed, 

2.  Skin  anaesthesia  or  hyperaesthesia. 

3.  Pain  greatly  increased  by  pressure. 


I. 
2, 

3- 

4- 
5- 
6. 

7- 

8. 

9- 

10. 


134 


DIFFERENTIAL  DIAGNOSIS. 


DISEASES  TO   BE  DIFFERENTIATED. 

Neuralgia. 


NAME   OF   DISEASE. 

Myalgia. 

4.  Pain  constant  and  tearing  in  char-      4.  Pain  paroxysmal  and  shooting. 

acter. 

5.  Pain  most  severe  at  points  of  at-      5.  Pain  most  severe  over  course   of 


tachment  of  muscle. 
6.  No  eruptions. 

Myalgia. 


nerve. 
6.  Frequent  herpetic  eruptions. 


Trichinosis. 

See  Trichinosis,  page  131. 

Myalgia.  Intestinal  Colic. 

See  Intestinal  ColiCy  page  67. 

Myalgia.  Spinal  Meningitis. 

See  Spinal  Meningitis,  page  146. 


DIFFERENTIAL    DIAGNOSfS    OF   THE    DISEASES    OF 
THE  NERVOUS  SYSTEM. 


DIFFERENTIAL    DIAGNOSIS    OF    THE    DISEASES    OF 
THE  NERVOUS  SYSTEM. 


DISEASES  OF    THE  BRAIN. 


NAME  OF  DISEASE. 


Acute  meningitis 


Chronic  meningitis 


Tubercular  meningitis 


Cerebral  softening 


Cerebral-apoplexy,  or  embolus 


DISEASES  TO  BE  DIFFERENTIATED. 

Uraemia. 
Typhus  fever. 
Small-pox. 
Delirium  tremens. 
Tubercular  meningitis. 
Pachymeningitis  interna. 

Cerebral  tumor. 

Cerebral  softening.  * 

Acute  meningitis. 
Spurious  hydrocephalus. 
Infantile  remittent  fever. 
Tubercular  enteritis. 
Cerebro-spinal  meningitis. 

Chronic  meningitis. 
Cerebral  tumor. 
Abscess  of  brain. 

Cerebral  embolus. 

Uraemia. 

Alcoholism. 

Opium  poisoning. 

Hysteria. 

Asphyxia. 

Epilepsy, 


137 


138 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


Abscess  of  the  brain  . 


Cerebral  tumor 


Cerebral  concussion 


Cerebral  tumor. 
Cerebral  softening. 

Abscess  of  the  brain."* 
Chronic  meningitis. 
Cerebral  softening. 

Cerebral  compression. 


DISEASES  OF  THE  CORD. 


Spinal  meningitis 


Myelitis     . 


Bulbar  paralysis 


Polio-myelitis  anterior 


Progressive  muscular  atrophy 


Cerebro-spinal  sclerosis 


Locomotor  ataxia 


Amyotrophic  lateral  sclerosis 


Tetanus, 
Myelitis. 
Muscular  rheumatism. 

Spinal  meningitis. 
Hysterical  paralysis. 
Spinal  apoplexy. 
Polio-myelitis  anterior. 
^  Congestion  of  the  cord. 

Bulbar  embolus  or  hemorrhage. 
Tumor  of  medulla. 
Progressive  muscular  atrophy. 

MyeHtis. 

Progressive  muscular  atrophy. 
Amyotrophic  lateral  sclerosis. 
Locomotor  ataxia. 

Polio-myelitis  anterior. 
Amyotrophic  lateral  sclerosis. 

Paralysis  agitans. 
Amyotrophic  lateral  sclerosis. 
Chorea. 

Polio-myelitis  anterior. 
Cerebellar  disease. 

Progressive  muscular  atrophy. 
Polio-myelitis  anterior. 
Cerebro-spinal  sclerosis, 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


139 


Epilepsy 


Hysteria 


Chorea 


Tetanus 


Paralysis  agitans 


FUNCTIONAL  NERVOUS  DISEASES. 

NAME   OF   DISEASE.  DISEASES   TO   BE   DIFFERENTIATED. 

'  Apoplexy. 
Hysteria. 
Opium  poisoning. 
Uraemia. 
Syncope. 
Organic  brain  diseases. 

Angina  pectoris. 

Cancer  of  oesophagus. 

Epilepsy. 

Uraemia. 

Acute  peritonitis. 

Hydrophobia. 

Myelitis. 

Chronic  laryngitis. 

Cerebro-spinal  sclerosis. 
Paralysis  agitans. 

Strychnia  poisoning. 
Spinal  meningitis. 
Hydrophobia. 

Cerebro-spinal  sclerosis. 

Chorea. 

General  paralysis  of  insane. 


DISEASES  OF  THE  BRAIN. 
Acute  Meningitis.  Uraemia. 

See  Ummia,  page  92. 
Acute  Meningitis.  Typhus  Fever. 

See  Typhus  Fever,  page   112. 
Acute  Meningitis.  Small-Pox. 

See  Small-Pox,  page  118. 


140 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF  DISEASE. 

Acute  Meningitis. 

See  Delirium 

Acute  Meningitis. 

1.  History  of  injury  or  acute  disease. 

2.  Begins  suddenly. 

3.  Temperature  liigh  and  constant. 

4.  No  peculiar  cry. 

5.  Usually  a  disease  of  adults. 

6.  Convulsions  appear  early. 

7.  Active  delirium. 

8.  Incoordinate  movements. 

Acute  Meningitis. 

1.  Begins  acutely. 

2.  Temperature  high. 

3.  General  headache. 

4.  Active  delirium. 

5.  No  apoplectic  seizures. 

6.  Marked  paralysis  uncommon, 

7.  Tdche  cerebrale. 


DISEASES    TO   BE   DIFFERENTIATED. 

Delirium  Tremens. 

Tremens,  page  132. 

Tubercular  Meningitis. 

1.  History  of  phthisis  or  tuberculosis. 

2.  Prodromata. 

3.  Temperature  lower  and  very  irreg- 

ular. 

4.  Hydrocephalic  cry. 

5.  Disease  especially  of  children. 

6.  Late  convulsions. 

7.  Mild  or  passive  delirium. 

8.  Automatic  movements. 

Pachymeningitis  Interna. 

1.  Prodromata. 

2.  Temperature  slightly  elevated. 

3.  Localized  and  vertical  headache. 

4.  Passive    delirium    or    simply    im- 

paired intellection. 

5.  Periods   of    sudden   loss    of    con- 

sciousness. 

6.  Paralysis  comes  on  gradually. 

7.  No  "cerebral  trace." 


Chronic  Meningitis. 

1.  History  of   head    injury  or  blood 

disease. 

2.  Headache  dull  and  constant. 

3.  Paralysis   not    limited    to    certain 

nerves. 

4.  Marked  general  decline  in  mental 

and  physical  powers. 

5.  Symptoms  of  a  general  nature.     ' 

6.  Speech  usually  unimpaired. 

7.  Great  irritability  of  temper. 


8.  Choked  discs  appear  late  if  at  all.         8 


Cerebral  Tumor. 

1.  Negative  history.  > 

2.  Headache  severe  and  paroxysmal. 

3.  Paralysis  of  certain   nerves  or  set 

of  nerves. 

4.  No  rapid  decline  in  mental  or  phys- 

ical powers. 
3.   Local  symptoms. 

6.  Speech  often  impaired. 

7.  Temper  not  especially  excitable. 
Choked  discs  appear  early. 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


141 


NAME   OF   DISEASE. 

Chronic  Meningitis. 

1.  History  of  head  injury  or   blood 

disease. 

2.  No  contraction  of  muscles. 

3.  Mental  excitement. 

4.  Great  irritability  of  temper. 

5.  Speech  usually  unimpaired. 

6.  No  disease  of  heart  or  arteries. 

7.  Constant  headache. 

8.  No  well-marked  paralysis. 

Tubercular  Meningitis. 

1.  History  of  tuberculosis. 

2.  Vomiting  projectile. 

3.  Constipation. 

4.  Abdomen  retracted. 

5.  No  special  thirst. 

6.  Flushing  of  one  cheek. 

7.  Pulse  slow  at  first. 

8.  Pupils  contracted. 

9.  Fever  irregularly  remittent. 


DISEASES   TO   BE   DIFFERENTIATED. 

Cerebral  Softening. 

1.  Often  a  history  of  apoplexy. 

2.  Muscular  contraction. 

3.  Mental  apathy. 

4.  Temper  not  excitable. 

5.  Speech  frequently  affected. 

6.  Heart  or  arterial  disease  common. 

7.  Inconstant  headache, 

8.  Paralysis  usually  well  marked. 

Infantile  Remittent  Fever. 

1.  History  of  gastro-enteritis. 

2.  Vomiting  retching. 

3.  Diarrhoea. 

4.  Abdomen  distended. 

5.  Great  thirst. 

6.  Flushing  of  both  cheeks. 

7.  Pulse  rapid. 

8.  Pupils  normal. 

9.  Fever  regularly  remittent. 


Tubercular  Meningitis.  Acute  Meningitis. 

See  Acute  Meningitis,  page  140. 

Tubercular  Meningitis.  Spurious  Hydrocephalus. 

See  Spurious  Hydrocephalus,  page  64. 

Tubercular  Meningitis.  Tubercular  Enteritis. 

See  Tubercular  Enteritis,  page  64. 

Tubercular  Meningitis.  Epidemic  Cerebro-Spinal  Menin= 

gitis. 

See  Epidemic  Cerebro-Spinal  Meningitis,  page  122. 

Cerebral  Softening.  Chronic  Meningitis. 

See  Chronic  Meningitis,  above. 


142 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF  DISEASE. 

Cerebral  Softening. 

1.  History  of  apoplexy  or  heart  dis- 

ease common. 

2.  Headache  dull  and  diffuse. 

3.  Speech   and    intellect  usually   af- 

fected. 

4.  No  facial  paralysis. 

5.  Epileptiform    convulsions   uncom- 

mon. 

6.  Symptoms  steadily  progressing. 

7.  Limbs  chiefly  affected. 


DISEASES   TO    BE   DIFFERENTIATED. 

Cerebral  Tumor. 

1.  Negative  history. 

2.  Local  pain  in  head. 

3.  Speech   and  intellect   not   greatly 

implicated. 

4.  Facial  paralysis  common. 

5.  Frequent  epileptiform  convulsions. 

6.  Symptoms   irregular   and   of   long 

duration. 

7.  Cranial    nerves    affected  ;  choked 

discs. 


Cerebral  Softening. 

I.  History  of  apoplexy  or  heart  dis-      i. 


ease  common. 

2.  Disease  of  months'  duration. 

3.  No  chills  or  fever. 

4.  Headache  dull  and  diffuse. 

5.  Hemiplegia  and  muscular  contrac- 

tions common. 

6.  Speech  and  intellect  affected  early. 


Cerebral  Apoplexy. 

1.  Disease  of  old  people. 

2.  Arteries  usually  diseased. 

3.  Aphasia  uncommon. 

4.  Complete  hemiplegia. 

5.  Frequent  loss  of  consciousness. 

6.  No   sudden  improvement  in  the 

paralysis. 

7.  Pulse  slow  and  full. 


2. 

3. 
4. 

5- 


Cerebral  Abscess. 

History  of  head  injury  or  disease 

of  ear. 
Disease  of  weeks'  duration. 
Chills,  fever,  and  sweating. 
Headache  local  and  acute. 
Hemiplegia  and  contractions  rare. 


6.  Speech,    intellect,   etc.,    not  early 
affected. 

Cerebral  Embolus. 

1.  Disease  of  young  people. 

2.  History  frequently  of   heart  dis- 

ease. 

3.  Aphasia  common. 

4.  Partial  hemiplegia. 

5.  Loss  of  consciousness  uncommon. 

6.  Improvement  in  symptoms  often 

followed  by  a  sudden  relapse. 

7.  Pulse  rapid  and  feeble, 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


H3 


NAME   OF   DISEASE. 


Cerebral  Apoplexy. 

8.   Pupils  unequal, 
g.  Vomiting  common, 
ro.   Breathing  stertorous. 


DISEASES    TO    BE    DIFFERENTIATED. 

Cerebral  Embolus. 

8.  Pupils  normal. 

9.  Rarely  vomiting. 
10.  Breathing  normal. 


Apoplexy  or  Embolus. 

6*1?^  Urcemia,  page  91. 


Uraemia. 


Apoplexy  or  Embolus. 

See 

Apoplexy  or  Embolus. 

1.  Pupils  irregular. 

2.  Convulsions  common. 

3.  Coma  appears  suddenly. 

4.  Pulse  irregular  and  full. 

5. 
6. 

7- 


9- 
10. 


Hemiplegia. 

Stertor. 

Face  flushed. 

No  odor  to  breath. 

Respirations  hurried. 

Skin  hot. 


Alcoholism. 

Alcoholism,  page  132. 

Opium  Poisoning. 

1.  Pupils  "  pin-head. " 

2.  No  Convulsive  movements. 

3.  Coma  deepens  gradually. 

4.  Pulse  slow  and  regular. 

5.  No  paralysis. 

6.  Shallow,  irregular  breathing. 

7.  Face  pale  and  cyanotic. 

8.  Odor  of  opium  about  patient. 

9.  Respirations  slow. 

10.  Skin  cool  and  perspiring. 


Apoplexy  or  Embolus. 

1.  History   of  heart   or  arterial  dis- 

ease. 

2.  Pupils  irregular,  pulse  slow. 

3.  Breathing  stertorous  and  hurried. 

4.  Frequent  loss  of  sensation. 

5.  Administration    of   ether    gives    a 

negative  result. 

6.  Moral  treatment  has  no  effect. 

Apoplexy  or  Embolus. 

1.  History  of  heart  or  other  arterial 

disease. 

2,  Tongue  never  bitten. 


Hysteria. 

1.  History  of  hysteria. 

2.  Pupils  regular,  pulse  rapid. 

3.  Breathing  catching  and  sobbing. 

4.  Hyperaesthesia  common. 

5.  Paralyzed     limbs     moved     during 

ether  administration. 

6.  Moral  treatment  curative. 

Epilepsy. 

1.  History  of  epilepsy. 

2,  Tongue  frequently  bitten. 


144 


DIFFERENTIAL   DIAGNOSIS   OF    THE 


NAME  OF  DISEASE. 

Apoplexy  or  Embolus. 

3.  No  permanent  rapid  improvement. 

4.  No  bloody  froth  about  mouth. 

5.  Pulse  full  and  slow. 

6.  Paralysis  follows  the  coma. 

7.  Coma  deepening. 

8.  Paralyzed  side  hot  and  red. 

Apoplexy  or  Embolus. 

1.  Face  pale  or  congested. 

2.  Breathing  stertorous. 

3.  Hemiplegia  common. 

4.  Pupils  irregular. 

5.  Pulse  full  and  strong. 

6.  Reflexes  absent    and    temperature 

higher  on  paralyzed  side. 

7.  Blood  red. 

Cerebral  Abscess. 

1.  History  of  injury  to   the  head  or 

disease  of  the  ear. 

2.  Emaciation. 

3.  Chills  and  sweatings. 

4.  No  local  paralysis. 

5.  No  choked  discs. 

6.  Headache  sudden  in  development. 

7.  Epileptiform  convulsions,  and  suc- 

ceeded by  paralysis. 

8.  Rapid  disease. 

Cerebral  Abscess. 


DISEASES  TO  BE  DIFFERENTIATED. 

Epilepsy. 

3.  Rapid  improvement. 

4.  Bloody  froth  about  mouth. 

5.  Rapid,  irregular,  and  feeble  pulse. 

6.  Sleep  follows  the  coma. 

7.  Coma   alternating  with   hysterical 

symptoms. 

8.  Both  sides  the  same. 

Asphyxia. 

1.  Face  turgid  and  cyanotic. 

2.  Distressed  and  embarrassed  breath- 

ing. 

3.  No  paralysis. 

4.  Pupils  regular. 

5.  Pulse  small  and  rapid. 

6.  Reflex   and  temperature  the  same 

on  both  sides. 

7.  Blood  blue. 

Cerebral  Tumor. 

1.  Negative  history. 

2.  No  rapid  emaciation. 

3.  No  chills  or  sweats. 

4.  Local  paralysis  of  long  standing. 

5.  Choked  discs. 

6.  Headache  gradually  increasing. 

7.  Spasm  of  single  muscles  or  group 

of  muscles,  and  not   followed  by 
paralysis. 

8.  Slow  disease. 

Cerebral  Softening. 


See  Cerebral  Softening,  page  144. 

Cerebral  Tumor.  Chronic  Meningitis. 

See  Chronic  Meningitis,  page  140. 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


145 


NAME   OF    DISEASE. 


DISEASES   TO    BE   DIFFERENTIATED. 


Cerebral  Tumor.  Cerebral  Softening. 

See  Cerebral  Softening,  page  142. 


Cerebral  Tumor. 


Cerebral  Abscess. 


See  Cerebral  Abscess,  page  144. 


Cerebral  Concussion. 


Cerebral  Compression. 


I. 

Symptoms  appear  immediately. 

I. 

Symptoms  appear  gradually. 

2. 

Power  of  speech  retained. 

2. 

Power  of  speech  lost. 

3- 

Special  senses  retained. 

3. 

Special  senses  blunted. 

4- 

Noiseless  respiration. 

4- 

Stertorous  breathing. 

5. 

Feeble  and  frequent  pulse. 

5. 

Slow  and  full  pulse. 

6. 

Sphincters  relaxed. 

6. 

Sphincters  contracted. 

7. 

Nausea  and  vomiting. 

7. 

No  vomiting. 

8. 

No  paralysis. 

8. 

Hemiplegia  common. 

9. 

Pupils  contracted  and  regular. 

9- 

Pupils  dilated  and  irregular. 

10. 

Lids  open  and  movable. 

10. 

Eyelids  shut. 

II. 

vSkin  cool  and  pale. 

II. 

Skin  hot  and  red. 

12. 

Mental  faculties  not  abolished. 

12. 

Mental  faculties  abolished. 

DISEASES 

OF  THE  CORD. 

Spinal  Meningitis. 

Tetanus. 

No  traumatic  history. 


Face  not  peculiar. 
No  jaw  symptoms. 
Great  pain  on  motion. 
Spasm    produced    by    attempts    to 
move. 

6.  Paralysis  follows  spasms. 

7.  Temperature  elevated. 

Spinal  Meningitis. 

1.  Fever. 

2.  Marked  rigidity  of  spine. 

3.  Cutaneous  hypergesthesia. 


1.  History  of  traumatism. 

2.  Risus  sardonicus. 

3.  Lockjaw. 

4.  Intense  hyperesthesia. 

5.  Spasm   caused   by  external   irrita- 

tion. 

6.  No  paralysis. 

7.  Temperature  nearly  normal. 

Lumbago. 

1.  Temperature  normal. 

2.  Apparent  rigidity  of  spine. 

3.  No  cutaneous  hyperaesthesia. 


146 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF    DISEASE. 

Spinal  Meningitis. 

4.  Spasms. 

5.  Paralysis. 

6.  No  tenderness  on  pressure. 

7.  Shooting  pains  along  the  course  of 

the  spinal  nerves. 

Spinal  Meningitis. 

1.  Pain  increased  by  moving. 

2.  Pain  shoots  in  direction  of  spinal 

nerves. 

3.  Tonic  spasm  of  hack  and   other 

muscles. 

4.  Increased  reflex  irritation. 

5.  Urine  normal  until   paralysis   is 

well  marked. 

6.  No  constricting  bands. 

7.  Sphincters  not  affected. 

8.  No  bed-sores. 

9.  Moderate  paralysis. 

10.  Short  duration. 

11.  Temperature  elevated. 

12.  Electro-contractility     of     muscle 

preserved. 

13.  Hyperaesthesia  of  skin. 

Myelitis. 

1.  Paralysis  well-marked. 

2.  Urine  alkaline. 

3.  Pain  on  pressure  along  cord. 

4.  Constricting  band  about  waist. 

5.  Bed-sores. 

6.  Anaesthesia  well  marked. 

7.  Wasting  of  muscles  affected. 


DISEASES   TO    BE   DIFFERENTIATED. 

Lumbago. 

4.  No  convulsions. 

5.  No  paralysis. 

6.  Tenderness  on  pressure  over  origin 

and  insertion  of  muscles. 

7.  No     shooting*  pain    along   spinal 

nerves. 

Myelitis. 

1.  Pain  increased  by  pressure. 

2.  No  darting  pains  along  nerves. 

3.  No  tonic  convulsions. 

4.  Diminished  reflex  action. 

5.  Urine  alkaline. 

6.  Constriction  about  waist. 

7.  Constipation  and  incontinence  or 

retention  of  urine. 

8.  Bed-sores  form  early. 

9.  Paraplegia. 

10.  Disease  of  long  duration. 

11.  Temperature  normal  usually. 

12.  Diminished      electro-contractility 

of  paralyzed  muscles. 

13.  Anaesthesia  of  affected  parts. 

Spinal  Congestion. 

1.  Paralysis  usually  slight. 

2.  No  urinary  symptoms. 

3.  No  pain  in  cord  on  pressure. 

4.  No  constricting  bands. 

5.  No  bed-sores. 

6.  Usually  hyperaesthesia. 

7.  No  wasting  of  muscles. 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


147 


NAME   OF   DISEASE. 

Myelitis. 

8.  Paralysis  progressive. 

9,  Paralysis  of  sphincters. 

10.   Electro-contractility    of    muscles 
diminished. 


Myelitis. 

1.  Fever. 

2.  Paralysis  usually  appears  gradually 

after  exposure  to  cold,  etc. 

3.  Bladder  symptoms   appear   gradu- 

ally. 

4.  Subjective  sensation  in  feet,  etc. 

5.  No  convulsions. 

6.  Pain  in  spine  increased  on  pressure. 

Myelitis. 


DISEASES   TO    BE   DIFFERENTIATED. 

Spinal  Congestion. 

8.  Diminishing  paralysis. 

9.  Sphincters  normal. 

10.  Electro-contractility  of  muscles 
preserved  and  sometimes  in- 
creased. 

Spinal  Apoplexy. 

1.  Temperature  normal. 

2.  Paralysis     comes     on    suddenly — 

often  the  result  of  injury. 

3.  Bladder    symptoms     appear     sud- 

denly. 

4.  No  subjective  sensations. 

5.  Tv^^itching  of  affected  muscles  com- 

mon. 

6.  No  pain  in  cord  on  pressure. 

Spinal  Meningitis. 


See  Spinal  Meningitis,  page  146. 

Myelitis.  Polio-myelitis  Anterior. 

I.   Sphincters  normal. 


1.  Paralysis  of  sphincters. 

2.  Bed-sores. 

3.  Anaesthesia. 

4.  Constriction  about  waist. 

5.  Urine  alkaline. 

6.  Paralysis  progressive. 

7.  No  rapid  wasting  of  muscles. 

8.  Temperature  of  affected  limbs  low- 

er than  normal. 

Myelitis. 

1.  History  of  exposure  to  cold,  syph- 

ilis, etc. 

2.  Urine  scanty  and  alkaline. 


2.  No  bed-sores. 

3.  Anaesthesia  absent  or  slight. 

4.  No  constricting  bands. 

5.  Urine  normal. 

6.  Symptoms   improve    under     treat- 

ment. 

7.  Rapid  wasting  of  affected  muscles. 

8.  Temperature     of     affected     limbs 

higher  than  normal. 

Hysterical  Paralysis. 

1.  History  of  hysteria. 

2.  Urine  acid  and  abundant. 


148 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Myelitis. 

3.  Urine  cloudy. 

4.  Constriction  about  waist. 

5.  Reflexes  diminished. 

6.  Diminished  electro-contractility  of 

muscles. 

7.  Pain  on  pressure  along  spine. 

8.  Disease  of  long  duration. 

9.  Moral  treatment  of  no  effect. 

Bulbar  Paralysis. 

1.  Bilateral  disease. 

2.  Progressive  paralysis  of  facial  and 

lingual  muscles. 

3.  Vomiting  inconstant. 

4.  ISlo  severe  neuralgic  pains. 

5.  No  epileptiform  attacks. 

6.  Special    senses   not    especially    af- 

fected. 

Bulbar  Paralysis. 

1.  Bilateral  disease. 

2.  Symptoms  appear  gradually. 

3.  Vomiting  infrequent. 

4.  No  convulsions. 

5.  No  loss  of  consciousness. 

6.  Paralysis  confined  to  cranial  nerves 

usually. 

Bulbar  Paralysis. 

X.   Paralysis  precedes  atrophy. 

2.  Thenar  and  hypothenar  eminences 

involved  late  if  at  all. 

3.  Atrophy  confined  to   the   muscles 

supplied  by  the  cranial  nerves. 

4.  Articulation  affected  early 


DISEASES    TO    BE   DIFFERENTIATr.D. 

Hysterical  Paralysis. 

3.  Urine  clear  and  limpid. 

4.  Globus  hystericus. 

5.  Reflexes  normal  or  increased. 

6.  Increased     electro-contractility    of 

muscles. 

7.  Pain  on  pressure  over  ovaries. 

8.  Disease  of  short  duration. 

9.  Moral  treatment  curative. 

Tumor  of  Medulla. 

1.  Disease  unilateral. 

2.  Convulsions   usually   precede    the 

paralysis  of  muscles. 

3.  Frequent  vomiting. 

4.  Facial  neuralgia. 

5.  Epileptiform  attacks  common. 

6.  Special    senses    affected ;    choked 

discs. 

Bulbar  Embolus  or  Apoplexy. 

1.  Unilateral  symptoms  predominate. 

2.  Disease  develops  suddenly. 

3.  Frequent  vomiting. 

4.  Epileptiform  convulsions. 

5.  Frequent  loss  of  consciousness. 

6.  Often  hemiplegia  or  paraplegia. 

Progressive  Muscular  Atrophy. 

1.  Paralysis  follows  atrophy.  "** 

2.  Thenar  centres  involved  early, 

3.  Atrophy  not   confined  to  muscles 

supplied  by  the-  cranial  nerves. 

4.  Articulation  affected  late  if  at  all. 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


149 


Polio-myelitis  Anterior. 

1.  Pain  not  severe. 

2.  Paralysis. 

3.  Normal  balancing  power. 

4.  Coordinate  movements. 

5.  Loss     of     electro-contractility     of 

muscles. 

6.  Muscular  atrophy  well  marked. 

7.  No  joint  or  eye  symptoms. 


Polio-myelitis  Anterior. 

See  Myelii's 

Polio-myelitis  Anterior. 

1.  Paroxysmal  increase  of  paralysis. 

2.  Paralysis  precedes  atrophy. 

3.  Reflexes  impaired  early. 

4.  Early   loss    of     muscular   electro 

contractility. 

5.  Temperature  highest   in    affected 

limbs. 

6.  General  atrophy  of  affected  parts. 

7.  No  fibrillary  contractions. 

8.  Pain  not  severe. 

9.  Rapid  disease. 

10.   Begins  in  muscles    of   lower  ex- 
tremity. 

Polio-myelitis  Anterior. 

I.   Large  muscles  early  affected. 
2     Pegins  in  lower  extremity. 

3,    No  rigidity  of  affected  limbs. 


Locomotor  Ataxia. 

1.  Lightning-like  pains. 

2.  No  true  paralysis. 

3.  Loss  of  balancing  power. 

4.  Incoordinate  movements  especially 

marked  when  the  eyes  are  closed. 

5.  Electro-contractility  of  the  muscLs 

preserved. 

6.  No  muscular  atrophy. 

7.  Joints  swollen,  impaired  eyesight, 

etc. 

"  Myelitis. 

page  146. 

Progressive  Muscular  Atrophy. 

1.  Steadily  progressive  paralysis. 

2.  Paralysis  follows  atrophy. 

3.  Reflexes  not  impaired  until  late. 

4.  Electro-contractility    of    muscles 

preserved. 

5.  Low     temperature     in      affected 

parts. 

6.  Atrophy    of    one    muscle    follows 

another. 

7.  Fibrillary  contractions  of  muscles. 

8.  Fulminating  pains, 
g.  Very  slow  disease. 

ro.    Usually  begins  in  small  muscles 
of  thumb. 


Amyotrophic  Lateral  Sclerosis. 

1.  Small  muscles  first  affected. 

2.  Often    attacks    upper    extremities 

first. 

3.  Well-marked    rigidity    of    affected 

parts. 


150 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME   OF   DISEASE. 

Polio-myelitis  Anterior. 

4.  No    well-marked    contractions    of 

fingers  or  toes. 

5.  Reaction  of  degeneration. 

6.  Diminished  tendon  reflex. 


DISEASES   TO    BE   DIFFERENTIATED. 

Amyotrophic  Lateral  Sclerosis. 

4.  "Bird-claw"  contractions   of   fin- 

gers and  toes. 

5.  No  reaction  of  degeneration. 

6.  Increased  tendon  reflex. 


Progressive  Muscular  Atrophy,         Amyotrophic  Lateral  Sclerosis. 


I.   Atrophy  precedes  the  paralysis. 


2. 


No    marked    rigidity   of    affected 
parts. 

3.  Very  slow  disease. 

4.  Normal  tendon  reflex. 

5.  Loss  of  electro-contractility  of  the 

affected  muscles. 

6.  Usually  begins  in    the  muscles  of 

ball  of  thumb. 

7.  Does  not  affect  all  the  limbs. 

8.  No  bulbar  paralysis  as  a  rule. 

^.   No   fibrillary  contractions    of    the 
muscles. 

Progressive  Muscular  Atrophy. 

.51?^  Polio-myelitis 

Cerebro-spinal  Sclerosis. 

(Multiple  Sclerosis.) 

1.  No  tremor  when  patient  is  at  rest. 

2.  Disease  of  young  adults. 

3.  Shaking  of  the  head. 

4.  Change  in  voice  and  speech. 

5.  Tendon  reflex  greatly  increased. 

6.  Patient    has    no    tendency  to  run 

forward. 

7.  Disease     usually     begins     in     the 

lower   extremities. 


1.  Atrophy  follows  the  paralysis. 

2.  Rigidity  of  paralyzed  parts. 

4.  Disease  progresses  quite  rapidly. 

4.  Increased  tendon  reflex. 

5.  Electro-contractility     of     muscles 
preserved. 

6.  Usually  begins  in  muscles  of  lower 
extremities. 

7.  Affects  both  extremities. 

8.  Usually   bulbar    paralysis    toward 
the  last. 

9.  Fibrillary  contractions  of  the  affec- 

ted muscles. 

Polio-myelitis  Anterior. 
Anterior,  page  149 

Paralysis  Agitans. 

1.  Continued  muscular  tremor. 

2.  Disease  of  the  aged. 

3.  No  violent  shaking  of  the  head. 

4.  Speech  slow. 

5.  Normal  tendon  reflex. 

6.  Patient  has  a  tendency  to  run  for- 

ward when  starting  to  walk. 

7.  Usually  first  noticed  in  the  hands. 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


151 


NAME   OF    DISEASE. 

Cerebro-spinal  Sclerosis. 


DISEASES    TO    BE    DIFFERENTIATED. 


Paralysis  Agitans. 

8.  Limbs  become  rigid. 

9,  Features  present  a  peculiar  physi- 

ognomy. 
10.  Voluntary  motion  beyond  control.       10.  Voluntary'  motion  can  be  accom- 
plished, but  with  trembling. 

11.  Intellect  remains  good. 

12.  Disease  steadily  progressive. 


8.   No  rigidity  of  the  limbs, 
g.   No  peculiar  physiognomy. 


11.  Patient  peevish  and  childish. 

12.  Periods  of  marked  improvement. 


Cerebro-spinal  Sclerosis. 

1.  Tendon  reflex  greatly  increased. 

2.  Muscular  atrophy  not  marked. 

3.  Voluntary  motion  beyond  control. 

4.  No  fibrillary  contractions. 

5.  No    claw-like    appearance    of   fin- 

gers, etc. 

6.  Mental  disturbance. 

7.  No  rigidity  of  affected  parts. 

8.  Periods  of  marked  improvement. 

Cerebro-spinal  Sclerosis. 

1.  Disease  of  young  adults. 

2.  Voluntary  motion  beyond  control. 

3.  Increased  tendon  reflex. 

4.  No  tremor  when  quiet. 

5.  Patient  can  keep  quiet  if  he  tries. 


6.   Both  sides  affected  alike. 


7.   Movements  the  same  in  character. 


Amyotrophic  Lateral  Sclerosis. 

1.  Tendon  reflex  slightly  increased. 

2.  Well-marked  muscular  atrophy. 

3.  Coordinate  voluntary  motion. 

4.  Fibrillary  contractions  of  muscles. 

5.  Claw-like    contractions    of   fingers 

and  toes. 

6.  Intelligence  good. 

7.  Rigidity  of  affected  parts. 

8.  Disease  steadily  progressive. 

Chorea. 

1.  Disease  of  childhood. 

2.  Voluntary   motion    under   control, 

but  incoordinate. 

3.  Normal  tendon  reflex. 

4.  Jactitations  when  quiet  and  often 

during  sleep. 

5.  Choreic  movements  more  marked 

when     patient    tries    to    appear 
quiet. 

6.  No     symmetrical     distribution    of 

symptoms  ;     often     confined     to 
one   side. 

7.  Movements   irregular  and   rapidly 

changing. 


152 


DIFFERENTIAL  DIAGNOSIS  OF  THE 


NAME    OF   DISEASE. 

Locomotor  Ataxia. 

No  headache  or  vertigo. 


No  Yomiting. 
Paraplegic  symptoms. 
Gait  abrupt  and  jerky. 
Cutaneous   sensibility   greatly  im- 
paired. 

6.  Walking  much  more  difficult  with 

eyes  closed. 

7.  Absence  of  knee-jerk. 

8.  Lightning-like  pains. 

Locomotor  Ataxia. 


DISEASES   TO    BE   DIFFERENTIATEDo 

Cerebellar  Disease. 

Headache  and  vertigo  common. 


Frequent  vomiting. 

Hemiplegia. 

Drunken  gait. 

Normal  cutaneous  sensibility. 


6.  Patient   walks    much   better   with 

the  eyes  closed. 

7.  Normal  reflexes. 

8.  No  severe  neuralgic  pains. 

Polio-myelitis  Anterior. 


See  Polio-myelitis  Anterior,  page  149. 

Amyotrophic  Lateral  Sclerosis.         Progressive  Muscular  Atrophy. 

See  Progressive  Muscular  Atrophy,  page  150. 

Amyotrophic  Lateral  Sclerosis.  Polio-myelitis  Anterior. 

See  Polio-myelitis  Anterior,  page  149. 

Amyotrophic  Lateral  Sclerosis.  Cerebro-spinal  Sclerosis. 

See  Cerebral-spinal  Sclerosis,  page  150. 

FUNCTIONAL   NERVOUS   DISEASES. 

Epilepsy.  Apoplexy. 

See  Apoplexy,  page  91. 

Epilepsy.  Uraemia. 

See  Urcemia,  page  91. 


Epilepsy  (Coma). 

1.  History  of  epilepsy.  i. 

2.  Coma  preceded  by  convulsions.  2. 

3.  Pupils  dilated.  3. 

4.  Temperature  elevated.  4. 

5.  Tongue  bitten,  5. 


Opium  Poisoning. 

History  usually  negative. 
No  convulsive  seizures. 
Pupils  contracted. 
Temperature     normal     or 

normal. 
No  injury  to  tongue. 


sub- 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


153 


NAME   OF   DISEASE. 

Epilepsy  (Coma). 

6.  Respiration  normal  or  rapid. 

7.  No  odor  to  breath. 

8.  Skin  hot  and  dry. 

9.  Pulse  rapid. 

10.   Bloody  froth  about  mouth. 

Epilepsy. 

1.  History  of  epilepsy. 

2.  Temperature  elevated. 

3.  General  muscular  rigidity. 

4.  A  lira  epileptica. 

5.  Anoesthesia. 

6.  Attacks  both  sexes. 

7.  No  apparent  cause. 

8.  Highly-colored  urine. 

9.  No  ovarian  tenderness. 

10.  Face  cyanosed. 

11.  Complete  loss  of  consciousness. 


12.  Biting  of  tongue. 

13.  Pupils  insensible  to  light. 

14.  Countenance  distorted. 

15.  Convulsions  tonic,  then  clonic. 

16.  Paroxysms  of  short  duration. 

17.  Paroxysms  followed  by  sleep. 

18.  Eyelids  half-open. 

Epilepsy. 

1.  Loss  of  consciousness  sudden. 

2.  Coma  preceded  by  convulsions. 


DISEASES    TO    BE   DIFFERENTIATED. 

Opium  Poisoning. 

6.  Slow,  shallow  respiration. 

7.  Odor  of  opium  about  patient. 

8.  Skin  cool  and  moist. 

9.  Pulse  slow. 

10.   No  frothy  mucus  aboHt  mouth. 

Hysteria. 

1.  History  of  hysteria. 

2.  Temperature  normal. 

3.  No  general  muscular  rigidity. 

4.  Globus  hystericus. 

5.  Hypersesthesia. 

6.  Attacks  females. 

7.  Caused  by  menstrual  disorders. 

8.  Urine  abundant,   clear,  and  lim- 

pid. 

9.  Ovarian  tenderness. 

10.  Face  flushed. 

11.  Loss  of  consciousness  incomplete, 

and  accompanied  with  sobbing, 
grinding  of  teeth,  etc. 

12.  Tongue  not  bitten. 

13.  Pupils  sensitive. 

14.  No  distortion  of  countenance. 

15.  Clonic  convulsions. 

16.  Paroxysms  often  of  some  length. 

17.  Paroxysms  followed  by  wakeful- 

ness. 

18.  Eyelids  closed. 

Syncope. 

1.  Loss    of    consciousness  comes   on 

slowly. 

2.  Coma  preceded  by  a  weak,  faint 

feeling. 


154  DIFFERENTIAL  DIAGNOSIS  OF  THE 

NAME  OF  DISEASE.  DISEASES  TO  BE  DIFFERENTIATED. 

Epilepsy.  Syncope. 

3.  Rapid  recovery.  3.   Slow  recovery. 

4.  Loss    of    consciousness    of    short       4.   Patient    remains   unconscious    for 

duration.  some  time. 

5.  No  recollection  of  the  attack.  5.   Patient  can  recall  the  facts    con- 

nected with  the  attack. 

6.  Pulse  not  greatly  affected.  6.   Pulse  very  weak,  hardly  felt  at  the 

wrist. 

7.  Hands  warm.  '  7.  Hands  and  feet  very  cold. 

Epilepsy.  Convulsions  Due  to  Organic  Brain 

Disease. 

1.  History  of  epilepsy.  i.  History  of  a  brain  disorder. 

2.  Advent  sudden.  2.   Advent  slow. 

3.  Attack  followed  by  sleep.  3.  Attack  often  followed  by  impaired 

intellect. 

4.  Apparently    a    complete    recovery       4.   Symptoms  of  brain  disorder  usually 

from  the  attack.  more   marked   after  an  epilepti- 

form attack. 

5.  Attack  preceded  by  a  well-marked       5.   No  aura  epileptica. 

aura. 

Hysteria.  Myelitis. 

See  Myelitis,  page  147. 

Hysteria.  Epilepsy. 

See  Epilepsy,  page  153. 

Hysteria.  Uraemia. 

See  Urcemia,  page  91. 

Hysteria.  Acute  Peritonitis. 

See  Acute  Peritonitis,  page  69. 

Hysteria.  Hydrophobia. 

See  Hydrophobia,  page  123. 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


155 


NAME   OF   DISEASE.  DISEASES   TO   BE   DIFFERENTIATED. 

Hysteria.  Chronic  Laryngitis. 

See  Chronic  Laryngitis,  page  16. 

Hysteria.  Angina  Pectoris. 

See  Angina  Pectoris,  page  42. 

Hysteria.  Cancer  of  the  CEsophagus. 

See  Cancer  of  the  CEsophagus,  page  54. 

Chorea.  Cerebro-Spinal  Sclerosis. 

See  Cerebro-Spinal  Sclerosis,  page  151. 


Chorea. 

1.  Disease  usually  of  young  people. 

2.  Spasmodic  contraction  of  muscles. 

3.  Loss  of  muscular  control. 

4.  No  general  disturbance. 

5.  Symptoms    usually   more    marked 

upon  one  side. 

6.  No  muscular  rigidity. 

7.  No  peculiar  physiognomy. 

8.  No  tendency  to  run  forward. 


Paralysis  Agitans. 

1.  Disease  of  adults. 

2.  Great  muscular  weakness. 

3.  Muscular  tremor. 

4.  Signs  of  general  decay. 

5.  Both  sides  of  body  alike  affected. 

6.  Muscular  rigidity  well  marked. 

7.  Physiognomy  peculiar. 

8.  Patient  loses  balance  when  about 

to  walk  and  runs  forward. 


Tetanus.  Spinal  Meningitis. 

See  Spinal  Meningitis,  page  145. 

Tetanus.  Hydrophobia. 

See  Hydtophobia,  page  123. 


Tetanus. 

History  of  traumatism. 
Arms  and  legs  last  affected. 
No  epigastric  pain. 
Slow  development  of  disease. 
5.  Spasms  affect  the  jaws  first. 


Strychnine  Poisoning. 

1.  No  traumatic  history. 

2.  Extremities  first  affected. 

3.  Severe  epigastric  pain. 

4.  Advent  sudden. 

5.  Jaws  secondarily  affected. 


156 


DISEASES  OF  THE  NERVOUS  SYSTEM. 


DISEASES   TO   BE    DIFFERENTIATED. 

Strychnine  Poisoning. 

Complete  muscular  relaxation  in 


NAME   OF   DISEASE. 

Tetanus. 

6.  Some  spasmodic  rigidity  constant- 

ly present. 

7.  Disease   lasts   usually    for   several 

days. 

Paralysis  Agitans. 

See  Cerebro- Spinal  Sclerosis,  page  150. 

Paralysis  Agitans.  Chorea. 

See  Chorea,  page  155. 


interval  between  spasms. 
Attack  of  short  duration. 


Cerebro-Spinal  Sclerosis. 


Paralysis  Agitans. 

1.  Voice  slow. 

2.  Intelligence    remains    good    until 

late  in  the  disease. 

3.  Physiognomy  peculiar. 

4.  Peculiar  gait. 

5.  No  trembling  of  the  head. 

6.  Tremor  constantly  present. 

7.  Disease  of  long  duration. 

8.  Unaltered  cutaneous  sensibility. 


General  Paralysis  of  the  Insane. 

1.  Voice  tremulous. 

2.  Intelligence  early  affected. 

3.  Dull  expression  to  face. 

4.  No  peculiar  gait. 

5.  Head  unsteady. 

6.  Inconstant  tremor. 

7.  Rapid  progressive  disease. 

8.  Altered  cutaneous  sensibility. 


DIFFERENTIAL  DIAGNOSIS  OF  COMA. 


.rr 


DIFFERENTIAL  DIAGNOSIS  OF  COMA. 


FORMS   OF  COMA  TO   BE  DIFFERENTIATED. 

Ursemic.  Hysterical. 

Apoplectic.  Congestive  (sunstroke.) 

Narcotic  (opium.)  Asphyxial. 

Alcoholic.  Anaemic  (syncope.) 

Diabetic.  Cerebral,  due  to  injury  to  brain. 

Epileptic. 

NAME  OF  DISEASE,  DISEASES  TO  BE  DIFFERENTIATED. 

Ursemic  Coma.  Apoplectic  Coma. 

See  UrcBmia,  page  91. 
Uraemic  Coma.  Narcotic  Coma. 

See  Ur(zmia,  page  92. 
Uraemic  Coma.  Alcoholic  Coma. 

See  Urce7nia,  page  92. , 
Uraemic  Coma.  Hysterical  Coma. 

See  Urcemia,  page  91. 
Uraemic  Coma.  Epileptic  Coma. 

See  Urcemia,  page  91. 

Uraemic  Coma.  Diabetic  Coma. 

1.  History  of  Bright's  disease,  1.   History  of  diabetes. 

2.  Albumen  and  casts  in  urine,  2.  Sugar  in  urine. 

3.  Begins  with   delirium   or   convul-       3.   Begins  with  somnolency  and  great 

sions.  oppression. 

159 


i6o 


DIFFERENTIAL  DIAGNOSIS  OF  COMA, 


NAME  OF  DISEASE. 

Ursmic  Coma. 
4.  Urine  scanty  and  retained. 


5. 

General  oedema. 

5. 

6. 

Uriniferous  odor  about  patient. 

6. 

7. 

Pulse  strong  and  full. 

Uraemic  Coma. 

7. 

1  History  of  Bright's  disease, 

2.  General  oedema. 

3.  Urine  albuminous. 

4.  Face  waxy. 

5.  Breathing  stertorous. 

6.  Uriniferous  smell  about  patient. 

7.  Heart's  action  usually  good. 

Uraemic  Coma. 

1.  History  of  Bright's  disease. 

2.  Temperature  low._, 

3.  Coma  and  repeated  convulsions. 


4.  Breathing  stertorous. 

5.  Urine  scanty  and  albuminous. 

6.  General  oedema. 

7.  Urine  retained. 

8.  No  diarrhoea. 
Coma  complete. 
Pulse  not  very  rapid. 


9- 
10. 


DISEASES  TO  BE  DIFFERENTIATED. 

Apoplectic  Coma. 

\,  Urine  abundant   and    passed   in- 
voluntarily. 
Emaciation. 

Sweet  odor  to  breath  and  urine. 
Pulse  weak  and  small. 

Asphyxia. 

1.  Of  exposure  to  foul  air. 

2.  CEdema  of  lungs. 

3.  Urine  negative. 

4.  Tongue  and  lips  livid  and  blue. 

5.  Breathing  embarrassed. 

6.  Breath  contains  large  amount  of 

carbonic  acid. 

7.  Heart  action  greatly  embarrassed. 

Congestive  Coma. 

(Sunstroke.) 

1.  Of  exposure  to  heat. 

2.  Temperature  high. 

3.  Coma  without  or  with  slight  con- 

vulsions. 

4.  Breathing  usually  quiet. 

5.  Urine  negative. 

6.  No  oedema. 

7.  Urine  passed  involuntarily. 

8.  Involuntary  diarrhoeal  discharges. 

9.  Coma  yields  readily  to  treatment. 
10.  Pulse  rapid. 


Apoplectic  Coma.  Alcoholic  Coma. 

See  Alcoholism^  page  132. 

Apoplectic  Coma.  Narcotic  Coma. 

See  Apoplexy,  page  143. 


DIFFERENTIAL   DIAGNOSIS   OF   COMA, 


i6i 


NAME  OF  DISEASE.  DISEASES  TO  BE  DIFFERENTIATED. 

Apoplectic  Coma.  Hysterical  Coma. 

See  Apoplexy^  page  143. 

Apoplectic  Coma.  Epileptic  Coma. 

See  Apoplexy,  page  143. 


Apoplectic  Coma. 

(Cerebral  hemorrhage.) 

1.  Apoplectic  history. 

2.  No  signs  of  injury. 

3.  No  oozing  from  nose  or  ears. 

4.  Stupor  intense  from  first. 

5.  Hemiplegia. 

6.  Remissions  infrequent. 

7.  No  headache. 

8.  Vaso-motor  disturbance  on  affected 

side. 

9.  Convulsions  and  paralysis  limited 

to  one  side. 

Apoplectic  Coma. 

1.  Hemiplegia. 

2.  Begins  suddenly. 

3.  Slow,  full  pulse. 

4.  Respiration  dow  and  stertorous. 

5.  Urine  negative. 

6.  Urine  often  retained. 

7.  Temperature   elevated,    especially 

on  paralyzed  side. 

8.  Pupils  irregular. 

g.  Deviation  of  head  and  eyes. 


Coma,  Result  of  Injury. 
(Meningeal  hemorrhage.) 

1.  History  of  injury. 

2.  Signs  of  head  injury. 

3.  Blood  or  serous  discharge  common. 

4.  Gradually  increasing  stupor. 

5.  Hemiplegia   comes  on   late,   if  at 

all. 

6.  Frequent  remissions. 

7.  Headache. 

8.  Vaso-motor     disturbance     uncom- 

mon. 

9.  Both  sides  may  be  affected. 

Diabetic  Coma. 

1.  No  true  paralysis. 

2.  Slowly,  with  somnolency. 

3.  Rapid,  weak  pulse. 

4.  Rapid  respiration. 

5.  Sugar  in  urine. 

6.  Passed      involuntarily     in      large 

quantities. 

7.  Temperature  normal. 

8.  Pupils  regular. 

9.  No  deviation. 


Apoplectic  Coma. 

Se^  Apoplexy,  page  144. 


Asphyxia. 


1 62 


DIFFERENTIAL  DIAGNOSIS  OF  COMA. 


NAME  OF  DISEASE. 

Apoplectic  Coma. 

1.  Apoplectic  history. 

2.  Appears  suddenly. 

3.  Temperature  higher  on  paralyzed 

side. 

4.  Hemiplegia. 

5.  Pupils  irregular. 

6.  Breathing  loudly  stertorous. 

7.  Deviation  of  head  and  eyes. 

8.  Retention  of  faeces. 

9.  Increasing  coma. 

10.  Pulse  slow  and  full. 


DISEASES  TO  BE  DIFFERENTIATED. 

Congestive  Coma. 

(Sunstroke.) 

1.  Exposure  to  heat. 

2.  Usually  comes  on  gradually. 

3.  Temperature  very  high  on  both 

sides. 

4.  No  true  paralysis. 

5.  Pupils  contracted. 

6.  Stertor  absent  or  low. 

7.  No  deviation. 

8.  Involuntary  diarrhceal  discharges. 

9.  Coma  diminishes  on  appropriate* 

treatment. 
10.  Pulse  rapid  and  often  feeble. 


Alcoholic  Coma.  Narcotic  Coma. 

See  Alcoholism f  page  133. 


Alcoholic  Coma. 

I.   History  of  alcoholism. 
2.'  Breath  smells  of  alcohol. 

3.  Alcohol  in  urine. 

4.  Temperature  low. 

5.  Tongue  negative. 

6.  Face  flushed  and  swollen. 

7.  No  loss  of  semen. 

8.  "Steamboat"  respiration. 

9.  Can  be  aroused  by  inhalation  of 

ammonia. 

10.  Coma  lasts  for  hours. 

11.  Not  preceded  by  convulsions. 


Epileptic  Coma. 

1.  History  of  epilepsy. 

2.  No  odor  to  breath. 

3.  Urine  negative. 

4.  Temperature  high. 

5.  Tongue  bitten. 

6.  Face   cyanotic   with   froth  about 

mouth. 

7.  Frequently  is. 

8.  No  stertorous  breathing. 

9.  Cannot  be  aroused. 

10.  Coma  of  short  duration. 

11.  Coma  follows  convulsions. 


Alcoholic  Coma. 


Congestive  Coma. 

(Sunstroke.) 
See  Alcoholism^  P^^g^  133' 


DIFFERENTIAL   DIAGNOSIS   OF   COMA. 


163 


NAME  OF  DISEASE. 

Alcoholic  Coma. 

1.  History  of  alcoholism. 

2.  Can  be  aroused. 

3.  Pulse  full  and  strong. 

4.  Pupils  dilated. 

5.  Alcohol  in  urine. 

6.  Face  flushed  and  red. 

7.  Steamboat  respiration. 

8.  Breath  smells  of  alcohol. 

Alcoholic  Coma. 

1 .  Breath  smells  of  alcohol. 

2.  Pulse  full  and  strong. 

3.  Alcohol  in  urine. 

4.  Urine  retained. 

5.  Can  be  aroused. 

6.  Begins  with  delirium. 

7.  Respiration  slow    and     steamboat 

quality. 

8.  Coma  gradually  lessens. 

Alcoholic  Coma. 

1.  History  of  alcoholism. 

2.  Usually  seen  in  males. 

3.  Stertorous  breathing. 

4.  Vomiting  common. 

5.  Coma  continuous. 

6.  Urine  retained. 

7.  Urine   high-colored   and    contains 

alcohol. 

8.  Breath  smells  of  alcohol. 


DISEASES  TO  BE  DIFFERENTIATED. 

Asphyxia. 

1.  Of  breathing  impure  air. 

2.  Cannot  be  aroused. 

3.  Pulse  small  and  weak. 

4.  Pupils  contracted. 

5.  Urine  negative. 

6.  Face  and  lips  blue. 

7.  Shallow  and  embarrassed  breath- 

ing. 

8.  Frequently  of  gas. 

Diabetic  Coma. 

1.  Sweet  odor  to  breath. 

2.  Pulse  rapid  and  weak. 

3.  Sugar  in  urine. 

4.  Urine  passed  involuntarily  and  in 

large  amounts. 

5.  Cannot  be  aroused. 

6.  Begins  with  somnolency. 

7.  Respiration  shallow  and  rapid. 


Coma  deepens. 

Hysterical  Coma. 

History  of  hysteria. 

Occurs  in  females. 

No  stertor. 

No  vomiting. 

Coma     alternates    with     hysterical 


delirium. 
Incontinence  of  urine. 
Urine  abundant  and  clear. 


8.  No  odor  to  breath. 


Epileptic  Coma.  Hysterical  Coma. 

See  Epilepsy,  page  153. 


164 


DIFFERENTIAL   DIAGNOSIS   OF   COMA. 


NAME  OF  DISEASE.  DISEASES  TO  BE  DIFFERENTIATED. 

Epileptic  Coma.  Narcotic  Coma. 

See  Epilepsy,  page  152. 


Epileptic  Coma. 


Syncope. 


See  Epilepsy,  page  153, 


Epileptic  Coma. 

1.  History  of  epilepsy. 

2.  Preceded  by  convulsions. 

3.  Coma  of  short  duration. 

4.  Temperature  elevated. 

5.  Pulse  not  greatly  affected. 

6.  Face  covered  with  foam. 

7.  Breathing  not  restrained. 

8.  Face  pale. 

Epileptic  Coma. 

1.  Begins  with  convulsions. 

2.  Face  cyanotic. 

3.  Pulse  not  affected. 

4.  Temperature  elevated. 

5.  Breathing  normal. 

6.  Urine  negative. 

7.  Coma  of  short  duration. 

8.  Seminal  emissions. 

Opium  Coma. 

1.  Comes  on  gradually. 

2.  Pupils  contracted. 

3.  Pupils  insensible. 

4.  Coma  deepens  gradually. 

5.  Breathing  very  slow  and  irregular. 

6.  Surface  cool  and  perspiring. 

7.  Opium  in  breath  and  urine. 


Asphyxia. 

1.  Of  breathing  impure  air. 

2.  May  end  in  convulsions. 

3.  Profound  coma. 

4.  Temperature  low. 

5.  Pulse  weak,  rapid,  and  small. 

6.  No  saliva  about  the  mouth. 

7.  Breathing  embarrassed. 

8.  Face  and  lips  very  blue. 

Diabetic  Coma. 

1.  Begins  with  somnolency. 

2.  Face  pale. 

3.  Pulse  weak  and  rapid. 

4.  Not  affected. 

5.  Breathing  very  rapid. 

6.  Urine  contains  sugar. 

7.  Coma  ends  in  death. 

8.  Incontinence  of  urine. 

Hysterical  Coma. 

1.  Appears  suddenly. 

2.  Pupils  normal. 

3.  Pupils  sensitive  to  light. 

4.  Coma    alternates   with    hysterical 

delirium. 

5.  Breathing  sighing  and  rapid. 

6.  Surface  flushed  and  hot. 

7.  Incontinence  of  limpid  urine. 


DIFFERENTIAL  DIAGNOSIS   OF  COMA, 


165 


NAME  OF  DISEASE. 


DISEASES  TO  BE  DIFFERENTIATED, 


Opium  Coma. 

Asphyxia. 

I, 

Pupils  contracted. 

I. 

Pupils  dilated  or  normal. 

2. 

Face  pale. 

2. 

Face  cyanosed. 

3. 

Breathing  very  slow  and  irregular. 

3. 

Breathing  rapid  and  embarrassed. 

4- 

Opium  in  breath  and  urine. 

4. 

Urine  and  breath  negative  or 
smell  of  coal  gas. 

5- 

Surface  cool  and  perspiring. 

5- 

Surface  dry  and  hot. 

6. 

Heart  negative. 

6. 

Heart's  action  greatly  interfered 
with. 

Opium  Coma. 

Diabetic  Coma. 

I. 

Breath  smells  of  opium. 

I. 

Sweet  breath. 

2. 

Opium  in  urine.  • 

2. 

Sugar  in  urine. 

3. 

Pulse  slow. 

3. 

Rapid,  weak  pulse. 

4- 

Breathing  slow  and  irregular. 

4. 

Rapid  breathing. 

5. 

Urine  retained. 

5. 

Incontinence  of  urine. 

6.  Pupils  contracted. 

7.  Surface  cool  and  perspiring. 

Diabetic  Coma. 

1.  History  of  diabetes. 

2.  Respiration  rapid. 

3.  Urine  contains  sugar. 

4.  Urine  passed  involuntarily. 

5.  Face  pale. 

6.  Sweet  smell  to  breath. 

7.  Convulsions  uncommon. 

8.  Coma  deepens. 

Diabetic  Coma. 

1.  History  of  diabetes. 

2.  Temperature  normal. 

3.  Urine  contains  sugar. 

4.  Incontinence  of  uriiie. 


6.  Pupils  negative. 

7.  Surface  dry  and  hot. 

Asphyxia. 

1.  Breathing  impure  air. 

2.  Greatly  embarrassed  breathing. 

3.  Urine  negative  or  suppressed. 

4.  Retention  of  urine. 

5.  Face  and  lips  blue. 

6.  Smells  of  gas  frequently. 

7.  Occasional  convulsions. 

8.  Coma  diminished  by  treatment. 

Congestive  Coma. 

(Sunstroke.) 

1.  Of  exposure  to  heat. 

2.  Temperature  elevated. 

3.  Urine  negative. 

4.  Incontinence  of  faeces, — diarrhoea. 


i66 


DIFFERENTIAL  DIAGNOSIS  OF  COMA. 


NAME  OF  DISEASE. 

Diabetic  Coma. 

5.  Pupils  normal. 

6.  Breathing  rapid. 

7.  Coma  deepens. 

Congestive  Coma, 

(Sunstroke.) 

1.  History  of  exposure  to  heat. 

2.  Coma  well-marked. 

3.  Temperature  slightly  elevated. 

4.  Pupils  contracted 

5.  Cannot  be  aroused. 

6.  Incontinence  of  faeces. 

7.  Diarrhoea. 

Syncope. 

1.  Advent  sudden 

2.  Face  pale. 

3.  Coma  of  short  duration. 

4.  Breathing  weak  but  not  restricted. 

5.  Surface  cold  and  perspiring. 

6.  Heart  principally  affected. 

7.  Pulse  not  felt  at  wrist. 


DISEASES  TO  BE  DIFFERENTIATED. 

Congestive  Coma. 

5.  Pupils  contracted. 

6.  Respiration  normal. 

7.  Coma  lessens  by  proper  treatment. 

Hysterical  Coma. 

1.  Hysterical  history. 

2.  Coma    alternates   with    hysterical 

symptoms. 

3.  Temperature  very  high. 

4.  Pupils  negative  or  dilated. 

5.  Can  be  aroused. 

6.  Incontinence  of  urine. 

7.  No  diarrhoea. 

Asphyxia. 

1.  Advent  slow. 

2.  Face  and  lips  blue. 


Coma  lasts  for  hours. 
Breathing  greatly  embarrassed. 
Surface  hot  and  dry. 
Lungs. 


INDEX. 


Abscess  of  the  brain,  144 
"       perinephritic,  103 
"       in  abdominal  wall,  79 
"       psoas,  62 
"       of  the  lung,  26 
of  the  liver,  78 
"       retro-pharyngeal,  15,  17 

Acid  fermentation  in  stomach,  56 

Acute  general  diseases,  107 

Alcoholism,  132 

Anaemia,  130 

"         pernicious,  130 

Ansemic  bruit,  44 

Aneurism,  abdominal,  46 
"  thoracic,  47 

Angina  pectoris,  42 

Aorta,  pulsations  of,  46 

Aortic  obstruction,  43 
"      regurgitation,  44 

Amyotrophic  lateral  sclerosis,  152 

Apoplexy,  cerebral,  142 
"         bulbar,  148 
"         spinal,  147 

Arteries,  diseases  of,  38,  46 

Arthritis  deformans,  129 

Ascites,  71 

Asphyxia,  144 

Asthenia,  30 

Atelectasis,  25 

B 

Bladder,  spasms  of,  103 

*'        distended,  72 
Bilious  remittent  fever,  116 


Brain,  diseases  of,  137 
Bright's  disease,  acute,  93 

"  "        chronic,  94 

Bronchitis,  acute,  27 
"  capillary,  27 

"  chronic,  28 

fetid,  28 
Broncho-pneumonia,  24 


Caecum,  cancer  of,  62 
"         distension  of,  62 

Calculi,  renal,  103 

Cancer  of  caecum,  62 
"         kidney,  loi 
"         liver,  82 
"         the  intestines,  65 

lung,  29 
"         the  pleura,  47 
"         peritoneum,  70,  71 
"         the  oesophagus,  53 
"         stomach,  57 
"         rectum,  61 
"         the  tongue,  14 

Cancrum  oris,  14 

Cardiac  dilatation,  40,  42 
"        enlargement,  39 
"       hypertrophy,  40 
"       murmurs,  43 

Cardialgia,  57 

Catarrh  of  the  bile  ducts,  77 

Cerebellar  disease,  152 

Cerebro-spinal  sclerosis,  150 

Chancre,  133 

Chancroid,  133 


167 


i68 


INDEX. 


Chicken-pox,  117 
Chlorosis,  130 
Cholera,  120 

**         infantum,  60 
"         morbus,  59 
Chorea,  155 

Chronic  general  diseases,  127 
Cirrhosis  of  the  liver,  77 
Cirrhotic  kidney,  95 
Colic,  hepatic,  85 

"      intestinal,  67 

"      renal,  103 

"      uterine,  68 
Coma,  159 

Compression  of  the  brain,  145 
Concussion  of  the  brain,  145 
Congestion  of  the  liver,  76 

"  "       spinal  cord,  146 

Consolidation  of  lung  tissue,  41 
Constipation,  chronic,  64 
Croup,  false,  15 

"        true  or  membranous,  15 
Cyst  of  kidney,  84 
Cystitis,  acute,  103 

D 

Delirium  tremens,  132 

Dengue  fever,  114 

Diabetes,  129 

Diarrhoea  with  hemorrhoids,  60 

Digestive  tract,  diseases  of,  51 

Dilated  heart,  40 

Diphtheria,  120 

Diphtheritic  sore  throat,  121 

Diseases,  acute  general,  107 

chronic  general,  127 
functional  nervous,  139 
of  the  arteries,  38,  46 
brain,  137 
digestive  tract,  51 
liver,  75 
lungs,  21 
heart,  37 
kidneys,  89 
mouth,  13 
nervous  system,  137 
peritoneum,  53,  68 


Diseases  of  the  spinal  cord,  138 
"  "      throat,  13 

Displacement  of  the  heart,  41 

Dropsy,  general,  96 
*'        ovarian,  71 

Dysentery,  60 

Dyspepsia,  55 

E 

Embolism,  cerebral,  142 

"  bulbar,  148 

Emphysema,  29 
Empyema,  33 

"  pulsating,  33 

Endocarditis,  40 

*'  ulcerative,  40 

Enlarged  gall-bladder,  79,  84 
Enteritis,  acute,  58 

' '         of  children,  60 

"         tubercular,  64 
Epilepsy,  152 
Epistaxis,  31 
Erysipelas  of  throat,  121 
Erythema,  119 

F 

Fatty  heart ,  42 

"     kidney,  96 

"     liver,  82 
Fevers,  107 
Floating  kidney,  65 
Functional  heart  murmurs,  40 


Gall-bladder,  enlarged,  79,  84 
Gangrene  of  the  lung,  28 
Gastritis,  acute,  54 
"         chronic,  55 
toxic,  54 
General  diseases,  acute,  107 
"  "  chronic,  127 

"        paralysis  of  insane,  156 
Glycosuria,  129 
Goitre,  cystic,  43 

"        exophthalmic,  43 
Gout,  acute,  128 
"      chronic,  129 


INDEX. 


169 


H 

Heart,  diseases  of,  37 

Hematemesis,  30 

Hematinuria,  99 

Hematuria,  99 

Hemoptysis,  30 

Hemorrhage,  intestinal,  66 

"  from  bladder,  99 

"  from  urethra,  99 

Hemorrhoids,  66 

Hydatids  of  liver,  83 
lung,  32 
"  kidney,  100 

Hydrocephalus,  141 

"        ^       spurious,  64 

Hydronephrosis,  100 

Hydrophobia,  123 

Hydro  thorax,  32 

Hysteria,  154 

Hysterical  change  of  voice,  16 

**          stricture  of  oesophagus,  54 


Infantile  remittent  fever,  60 
Insane,  paralysis  of,  156 
Intercostal  neuralgia,  31 
Intermittent  fever,  115 
Intestinal  hemorrhage,  66 
"         obstruction,  63 
"         perforation,  67 
Intestine,  diseases  of,  51 
Intussusception,  63 


Jaundice,  hematogenous,  86 
"         hepatogenous,  86 
"         simple,  81 

K 

Kidney,  diseases  of,  89 

L 

Large  white  kidney,  94 
Laryngitis,  acute,  15 
chronic,  i6 


Larynx,  oedema  of,  16 

*'        spasmodic  affections  of,  30 
Leucocythemia,  131 
Liver,  diseases  of,  75 
Locomotor  ataxia,  152 
Lungs,  diseases  of,  21 

M 

Malignant  pustule,  14 
Measles,  119 
Meningitis,  acute,  139 

"  chronic,  140 

"  epidemic     cerebro-spinal, 

122 
Meningitis,  spinal,  145 

"  tubercular,  141 

Mitral  obstruction,  45 

"      regurgitation,  46 
Mouth,  diseases  of,  13 
Murmurs,  cardiac,  38,  43 
Myalgia,  133 
Myelitis,  146 

N 

Nephritis,  89 

Nervous  system,  diseases  of,  137 

Neuralgia,  134 

"  intercostal,  31 

O 

CEdema  of  glottis,  16 

lungs,  28 
(Esophagus,  cancer  of,  53 

"  stricture  of,  53 

Organic  brain   disease,  154 

"       heart  disease,  42 
Ovarian  cyst,  100  t 

"       dropsy,  71 


Pachymeningitis  interna,  140 
Palpitation  of  the  heart,  42 
Paralysis  agitans,  156 
bulbar,  148 
"        of  insane,  156 


i^o 


iNpEX, 


Perforation,  intestinal,  67 

Pericarditis,  39 

Perihepatitis,  84 

Perinephritis,  103 

Periproctitis,  65 

Peritoneum,  diseases  of,  53,  68 

Peritonitis,  acute,  68 
"  chronic,  70 

"  cancerous,  70,  7r 

"  tubercular,  71 

Perityphlitis,  61 

Pernicious  anaemia,  130 

"  remittent  fever,  116 

Phthisical  cavities,  32 

Phthisis,  acute,  25 
"        chronic,  26 

Pleurae,  cancer  of,"  47 

Pleurisy,  acute,  31 

"         with  effusion,  32 

Pneumonia,  acute  lobar,  23 
"  broncho-,  24 

Pneumothorax,  32 

Poisoning,  acute,  54 
"  opium,  92 

"  strychnine,  155 

Polio-myelitis  anterior,  149 

Pregnancy,  72 

Proctitis,  65 

Progressive  muscular  atrophy,  150 

Pseudo  leukaemia,  131 

Psoas  abscess,  62 

Pulmonary  .nfarction,  27 
"  regurgitation,  45 

"  consolidation,  41 

Pulsation,  abdominal,  46 

Purpura,  13 1 

Pyaemia,  122 

Pyelitis,  97 

Pylephlebitis,  80 

Pyonephritis,  97  _ 


R 


Relapsing  fever,  114 
Remittent  fever,  115 

"      infantile,  60 
**  "      pernicious,  116 


Retro-pharyngeal  abscess,  15,  17 

Rheumatism,  acute,  128 
"  chronic,  129 

"  gonorrhoeal,  128 

"  muscular,  133 

Roseola,  120 


Scarlet-fever,  118 

Scurvy,  131 

Septicaemia,  122 

Small-pox,  116 

Softening  of  the  brain,  141 

Sore  throat,  diphtheritic,  121 

Spasmodic  affections  of  larynx  30 

Spasm  of  bladder,  103 

Spinal  cord,  diseases  of,  138 

Stomach,  diseases  of,  51,  54 

"         cancer  of,  57 

"         ulcer  of,  57 
Stomatitis,  follicular,  13 

* '  ulcerative,   14 

Sun-stroke,  133 
Suppurative  nephritis,  98 
Syncope,  153 
Syphilis,  133 
Syphilitic  ulcer  of  tongue,  14 


Tetanus,  155 

Throat,  diseases  of,   13 

Thrush,  13 

Tubercle  of  kidney,   102 

Tuberculosis,  acute,  ill 

Trichinosis,  131 

Tricuspid  regurgitation,  46 

Tumor  of  spleen,  102 
"         liver,  loi 
"         brain — cerebral,  145 
"         medulla,  148 

Tumors  of  abdomen,  46 

Typhilitis,  61 

Typhoid  fever,  109 

Typho-malarial  fever,  no 

Typhus  fever,  in 


V 


INDEX. 


171 


u  w 

mach, 
gue, 
Uraemia,  91 


Ulcer  of  stomach,  57  Waxy  kidney,  96 

"       tongue,   14  "       liver,  82 


,^      .  ,      ,  Yellow  atrophy  of  liver,  acute,  80 

Vertigo,  cerebral,  56  Yellow  fever,  113 


MANUAL    OF    DIFFERENTIAL    MEDICAL 

DIAGNOSIS. 

By  CONDICT  W.  CUTLER,  M.S.,  M.D.' 


EXTRACTS  FROM  PRESS  NOTICED. 


"  It  is  a  ready  helper  to  the  hurried  practitioner,  and  is  another  of  those  books  that  should 
always  be  convenient  on  the  doctor's  table." — Virginia  Medical  Monthly. 

"  A  most  excellent  little  manual  of  diagnosis  covering  all  those  affections  treated  of  in  the 
text-books  of  medicine,  and  presenting,  in  contrasted  tabular  form,  the  conspicuous  features 
common  to  or  distinctive  of  each.  .  .  .  The  task  seems  to  have  been  accomplished  in  a 
most  thorough  and  satisfactory  way." — Medical  Press  of  Western  New  York. 

"  This  manual  has  decided  merit,  and  will  commend  itself  to  every  one  engaged  in  the  study 
of  medicine.  A  brief  yet  excellent  introduction  is  devoted  to  the  course  which  should  be  fol- 
lowed in  the  examination  of  patients,  and  a  systematic  method  is  delineated, 

"  The  author  has  wisely  selected  only  those  diseases  most  liable  to  be  confounded,  and  has 
not  burdened  his  manual  with  unnecessary  matter. 

"  The  book  thus  gains  in  brevity,  is  more  pointed  and  concentrated,  and  yet  is  sufficiently 
exhaustive  and  comprehensive. 

"  The  arrangement  of  the  work  is  sirnple  and  natural,  and  the  method  by  which  it  is  placed 
before  the  eye  of  the  student  is  excellent,  The  author  displays  rare  skill  and  judgment  in  con- 
trasting diseases.  His  differentiation  is  clear  but  not  too  sharply  drawn,  and  displays  extensive 
labor  and  research,  as  well  as  practical  knowledge. 

"  This  little  volume  will  prove  of  great  assistance  to  the  undergraduates,  and  is  an  in- 
valuable aid  to  the  graduate  who  intends  to  compete  for  a  hospital  appointment." — New  York 
Medical  yournal. 

"  The  appearance  of  this  book  in  this  form  is  timely.  ...  Its  value  is  chiefly  for 
students,  .  .  .  but  will  serve  a  useful  purpose  for  older  physicians  in  active  practice.  .  .  . 
It  is  a  good  reference-book  to  set  the  machinery  of  thought  and  differential  diagnosis  in  active 
and  fruitful  motion  in  the  mind.  .  .  .  The  author  has  done  his  work  with  sufficient  accuracy 
to  meet  professional  approbation,  and  to  be  of  service  to  the  profession. 

"  It  ought  to  afford  valuable  hints  to  lectures  on  clinical  medicine." — Alienist  and  Neu- 
rologist. 

"  He  (the  author)  deserves  credit  for  his  careful  collation." — Philadelphia  Medical  and 
Szirgical  Reporter. 

"  The  arrangement  is  convenient,  and  will  be  helpful  to  the  student  in  formulating  and 

,173 


1/4  EXTRACTS  FROM  PRESS  NOTICES. 

making  definite  in  his  mind  the  contrasting  as  well  as  the  similar  features  of  the  various  dis- 
eases."— St.  Louis  Courier  of  Medicine. 

"  The  student  will  find  It  greatly  to  his  profit  to  study  those  (diagnosis  tables)  of  Dr.  Cutler, 
which  would  serve  him  as  a  key  to  correct  his  own  by,  as  they  are  models  of  thoughtfulness." 
— New  York  Medical  Record. 

"  The  book  is  an  excellent  one,  .  .  .  and  will  be  appreciated  by  those  who  have  not 
time  or  facilities  for  reference  to  larger  works." — Colujnbus  Medical  Journal. 

"  This  little  work  will  be  valuable  as  a  book  of  reference.  .  .  .  There  are  times  when 
such  an  arrangement,  as  given  by  the  author,  will  be  found  exceedingly  convenient.  The 
work  is  carefully  done,  and  the  book  presents  a  very  neat  appearance.  It  will  save  the  student 
many  an  hour  of  physical  work  in  writing  out  tables  of  differential  diagnosis  for  himself." — 
Canada   Lancet. 

"  It  would  certainly  serve  a  purpose  in  the  way  of  assisting  students  to  prepare  for  written 
or  oral  examinations." — Canada  Medical  and  Stirgical  yournal. 

"  It  seems  to  present  the  subject  well,  and  attracts  one  by  the  pleasant,  easy  style." — New 
England  Monthly. 

"  The  book  is  unique  in  its  arrangement  and  in  the  exact  ground  covered.  ...  It  will 
be  the  saving  of  a  great  deal  of  work  to  the  student  into  whose  hands  it  falls.  Shorn  of  the 
verbiage  of  larger  works,  and  condensing  the  pith  of  all,  it  is  an  invaluable  book  for  students 
in  medicine." — The  Medical  Analectic. 

"  Where  diseases  are  most  liable  to  be  confounded  with  each  other,  and  a  careful  diagnosis 
is  necessary  to  decide,  this  work  will  certainly  lend  a  helping  hand.  .  .  .  We  commend 
the  work  as  worthy." — Medical  Brief, 

"  We  have  given  it  a'tolerably  careful  examination,  and  are  pleased  to  find  it  accurate  and 
intelligible.  .  .  .  He  has  succeeded  in  his  endeavors  to  present  to  the  student  and  prac- 
titioner a  digest  of  symptomatology." — London  Lancet. 

"  This  will  prove  a  practical  and  useful  manual."     .     .     . — Nashville  jfournal. 

'^  The  compact  and  concise  method  of  tabulating  the  distinguishing  symptoms  of  disease 
renders  the  work  available  to  the  busy  practitioner  In  any  case  of  obscure  or  doubtful  diagnosis. 

.  .  The  book  is  well  printed,  and  will  be  found  very  convenient  on  the  office  table." — 
A  rchives  of  GyncBcology, 

"  Tables  of  the  symptoms  by  which  the  various  diseases  may  be  distinguished  from  each 
other,  are  given  in  parallel  columns  ;  under  pneumonia,  for  instance,  four  tables  in  which  the 
symptoms  of  that  disease  are  contrasted  with  those  produced  by  acute  pleurisy,  pleurisy  with 
effusion,  acute  phthisis,  and  broncho-pneumonia. 
"  Tabular  statements  of  this  kind  are  useful,  etc." — British  Medical  Journal. 


PUBLICATIONS    OF  G.  P.   PUTNAM'S    SONS. 

STUDENTS'    MANUALS. 

Manual  of  Prescription  Writing.  By  Matthew  D. 
Mann,  M.D.,  late  Examiner  in  Materia  Medica  and 
Therapeutics  in  the  College  of  Physicians  and  Surgeons, 
New  York.     Revised  edition.     i6mo,  cloth.     $r.oo. 

Manual     of    Practical     Normal     Histology.      By    T. 

Mitchell  Prudden,  M.D.,  Director  of  the  Physiologica, 
and  Pathological  Laboratory  of  the  Alumni  Association  of 
the  College  of  Physicians  and  Surgeons,  N.  Y.,  etc. 
i6mo,  cloth.     $1.25. 

Students*  Manual  of  Venereal  Diseases,  being  the 
University  Lectures  delivered  at  Charity  Hospital,  B.  I., 
during  the  Winter  Session  of  1879-80.  By  F.  S.  Sturgis, 
M.D.,  Clinical  Lecturer  on  Venereal  Diseases  in  the  Medi- 
cal Department  of  the  University  of  the  City  of  New 
York,  etc.,  etc.     Fourth  edition.     i6mo,  cloth.     S^-^S- 

Students'  Manual  of  Diseases  of  the  Skin.  By  L.  D. 
BuLKLEY,  M.D.     Large  i6mo.     lT.25. 

Students'  Manual  of  the  Diseases  of  the  Nose  and 
Throat.  By  J.  M.  W.  Kitchen,  M.D.  i6mo,  illus- 
trated, cloth.     $1.00. 

Students'  Manual  of  the  Pharmacopoeia  of  the  Dis- 
eases of  .the  Throat.  By  George  M.  Lefferts, 
M.D.     $1.00. 

Students'  Manual  of  Rational   Electro-Therapeutics. 

By  R.  W.  Amidon,  A.M.,  M.D.,  Lecturer  on  Therapeutics 
at  the  Woman's  Medical  College  of  the  N.  Y.  Infirmary, 
etc.,  etc.     i6mo.     $1.00. 

Students'   Manual  of  Diseases    of  the   Nerves.     By 

E.  C.  Seguin,  M.D.     {In preparation.) 

G.  P.  PUTNAM'S  SONS,   New  York  and  London. 


Valuable  Books  for  Everybody. 


WORK  FOR  WOIIIEN.  Being  Hints  to  aid  Women  in  the  Selec- 
tion of  a  Vocation  in  Life,  and  Describing  the  Several  Occupations  of  Short- 
Hand  Writing,  Industrial  Designing,  Photographing,  Nursing,  Telegraphing, 
Teaching,  Dress-Making,  Proof-Reading,  Engraving,  etc.,  etc.,  etc.  By 
George  J.  Manson.      i6mo,  boards  ......         60 

This  book  is  th.oroughly  practical  in  character,  and  aims  to  be  a  real  help  to 
that  large  and  growing  class  of  women  who,  either  from  choice  or  through  necessity, 
are  trying  to  discover  how  they  can  make  a  living.  The  information  is  thoroughly 
reliable,  having  been  obtained  from  the  best-known  sources,  and  it  is  confidently 
believed  that  the  little  book  will  meet  a  popular  demand. 

HOW  TO  MAKE  A  LIVING.  By  George  Gary  Eggleston,  au- 
thor of  "  How  to  Educate  Yourself."     i6mo,  paper  ...         30 

"  Shrewd,  sound,  and  entertaining." — N.  Y.  Tribune. 

"  An  admirable  little  treatise,  full  of  sound  practical  advice." — Christian  Union. 

HOW  TO  EDUCATE  YOURSELF,  A  complete  guide  to 
Students  ;  showing  how  to  study,  what  to  study,  and  how  and  what  to  read. 
It  is,  in  short,  a  "  Pocket  School-master."  By  George  Gary  Eggleston. 
i6mo,  151  pages,  paper  ........         30 

"  We  write  with  unqualified  enthusiasm  about  this  book,  which  is  untellably 
good  and  for  good."— .A''.  Y.  Evening  Mail. 

TILL  THE  DOCTOR  COMES,  AND  HOW  TO  HELP 
HIM.  By  George  H.  Hope,  M.D.  Revised,  with  additions,  by  a 
New  York  physician.  A  popular  guide  in  all  cases  of  accident  and  sudden 
illness.     i6mo,  99  pages,  paper          .         .         .         .         .         .         .         30 

"  A  most  admirable  treatise  ;  short,  concise,  and  practical."— .^^r/^;-'j  Monthly 
(Editorial). 

"  We  find  this  an  invaluable  little  compendium,  embracing  more  information  of  use 
to  by-standers  in  time  of  sickness  or  accident  than  we  have  ever  seen  put  together  be- 
fore. If  one  will  study  this  small  book  well,  put  it  in  his  pocket,  and  follow  its  direc- 
tions carefully,  he  will  often  save  some  poor  fellow's  life,  when  a  little  delay  might 
cause  its  loss." — Athol  Transcript. 

"  A  perfect  gem  for  the  sick-room,  and  should  be  in  every  family." — Venango  Spec- 
tator. 

G.  P.  PUTNAM'S  SONS,  PUBLISHERS, 

NEW  YORK  AND  UONPON. 


— _  '^  ^1  ■ 

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